Medicine and Health Sciences Commons^™

Sleep, Sleepiness, And Driving Performance In Healthcare Shiftworkers, Melissa Knott

Electronic Thesis and Dissertation Repository

Almost half of Canadian healthcare workers are employed in rotating day/night shifts to provide essential 24-hour services. However, poor sleep quantity and quality are pervasive in shiftwork and may negatively impact cognitive functions required for driving. Furthermore, healthcare shiftworkers (HCSW) are under-represented in research examining shiftworkers’ sleep and driving performance. Thus, this dissertation examined sleep, sleepiness and driving performance in HCSW via three aims. First, chapter 2 aimed to quantify and describe HCSWs’ sleep-related driving experiences and advance the understanding of occupational adaptations used by HCSWs to meet driving demands. Second, chapter 3 aimed to quantify differences in sleep, sleepiness, …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

Developing Rehabilitation Treatment Decision Aid For People Living With Complex Regional Pain Syndrome (Crps), Erfan Shafiee

Electronic Thesis and Dissertation Repository

This Ph.D. dissertation aimed to develop a treatment decision aid for people with Complex Regional Pain Syndrome (CRPS) using the Ottawa Decision Support Framework (ODSF). The decision aid was developed throughout a two-phase process.

The first phase involved understanding the existing evidence and the factors influencing decision-making in CRPS rehabilitation: priorities and preferences of patients and therapists were considered. This phase encompassed the integration of diverse sources of evidence, including systematic reviews, overview of systematic reviews, critical appraisal of guidelines, and a survey exploring patients' and therapists' priorities and preferences for CRPS rehabilitation interventions. All forms of evidence were used …

The Clinical Value Of Oculomotor Assessments Across The Continuum Of Concussion, Dillon Richards

Electronic Thesis and Dissertation Repository

Concussions are complex conditions that are difficult to manage medically. Variations in symptom presentation, intricate neurophysiological processes, and the availability of a variety of possible assessment tools may contribute to this complexity. Clinicians must use a broad approach, employing both subjective symptom assessment and objective assessments to confirm a diagnosis and/or monitor progression and recovery. Oculomotor function after concussion may be an important indicator of injury, given the interconnectedness of oculomotor function, vestibulo-ocular and visual systems, and even cognition. Oculomotor function may be assessed objectively or indirectly using patient-reported symptom checklists as part of subjective assessments. One way of objectively …

Adaptation With Injury, Family Role Responsibilities, & Social Support After Distal Radius Fracture (Drf), Hajra Batool

Electronic Thesis and Dissertation Repository

This study is a qualitative interpretive descriptive study aimed at elucidating the impact of distal radius fracture (DRF) on patients' activities of daily living (ADLs), professional and familial duties, and social support during the healing process. The study focuses on fracture healing during the immobilization phase of injury. This study lies in the constructivist paradigm employing the interpretive description method. A total of 20 participants with DRF in casts were recruited by purposeful sampling from the Hand & Upper limb Centre, St. Joseph’s Hospital enrolled and interviewed over the telephone. Data was analyzed by Braun and Clarke’s Thematic Analysis Approach. …

The Coping Strategies Of Older Adults With Age Related Vision Loss (Arvl) – A Narrative Account, Zakara J. Stampp

Electronic Thesis and Dissertation Repository

The goal of this study was to share the stories of older adults with age-related vision loss (ARVL) and how they have coped to maintain meaningful occupational engagement. Grounded in a constructivist paradigm, data collection and analysis were guided by the narrative inquiry methodology. The participants consisted of six older adults aged 60 or older, diagnosed with one of the following ARVL conditions: macular degeneration, diabetic retinopathy, and/or glaucoma. Participants were recruited from vision loss non-profit organizations such as the Canadian National Institute for the Blind (CNIB) and the Alliance for Equity of Blind Canadians (AEBC). One older adult was …

Lived Experience Of Having Difficult Conversations Among Care Partners Of Individuals With Parkinson's: An Occupational Science Perspective, Helen A. Reid

Electronic Thesis and Dissertation Repository

Difficult conversations, which can be challenging co-occupations, play an important role in the lives of care partners of individuals living with Parkinson’s disease. In our first study for this integrated-article thesis, we used a critical interpretive synthesis to explore how informal caregiving had been conceptualized in occupation-focused research. We found that an occupational perspective illuminated otherwise overlooked aspects of caregiving. In our second study, we used an occupational science lens to explore how seven care partners of individuals with PD experienced having difficult conversations within the caring role. We conducted two rounds of in-depth semi-structured interviews and used an American …

Troubling Service User Involvement In Health Professional Education: Toward Epistemic Justice, Stephanie Leblanc-Omstead

Electronic Thesis and Dissertation Repository

It has become increasingly popular in health professional education to solicit the contributions and involvement of people who have firsthand or ‘lived’ experiences of using mental health services – a practice hereafter referred to as service user involvement (SUI). SUI is founded on the premise that service users ought to be involved in the development and evaluation of services and systems they experience, which includes the education of future health professionals. Despite the momentum this practice has gained in a range of international contexts, SUI is often conceptualized, organized, and implemented uncritically, and with tremendous inconsistency across health professional education …

The Problem Of Operational Stress Injuries In An Ontario Fire & Rescue Organization, Megan Edgelow

The Dissertation in Practice at Western University

The purpose of this Organizational Improvement Plan (OIP) is to assist public safety leaders in understanding the human and financial costs of operational stress injuries (OSIs) and possible solutions to this issue. OSIs, including posttraumatic stress disorder (PTSD), are a growing problem for public safety organizations, requiring new and innovative solutions. This OIP is applied to a fire and rescue organization in a small urban centre in Ontario that faces similar OSI challenges to many other public safety organizations. The Problem of Practice (PoP) is a lack of implementation of effective practices to mitigate the impact of OSIs. The foundation …

Occupational Engagement Of Older Adults With Age-Related Vision Loss (Arvl): Understanding The Influences Of Social Networks, Ji Won Kang

Electronic Thesis and Dissertation Repository

The present study sought to understand how older adults’ social networks facilitate and constrain their engagement in meaningful occupations after being diagnosed with age-related vision loss (ARVL). A constructivist paradigm and narrative inquiry methodology were used to elicit and make sense of the participants’ unique stories. The participants consisted of five older adults 60 years and older, living with ARVL, including one of the following conditions; macular degeneration, glaucoma, and diabetic retinopathy. Participants were recruited from the Canadian National Institute for the Blind (CNIB) and Society for Learning and Retirement (SLR). Data was collected through three sessions of semi-structured, audio-recorded …

Navigating The “Blind World”: The Psychosocial And Occupational Experiences Of Parents Of Adolescents With Visual Impairments, Peiwen Cao

Electronic Thesis and Dissertation Repository

Using a constructivist narrative inquiry approach, this research study sought to explore how parents of adolescents with visual impairments story their psychosocial and occupational experiences. Participants of the study consisted of four parents who were currently raising adolescents with visual impairments between the ages of 14 to 17. Participants took part in two in-depth narrative interviews, in which they answered several open-ended questions about their experiences of raising their adolescent children who were visually impaired. Participants also participated in a brief concluding interview session, in which they provided feedback on the narrative that I constructed based on their interview responses. …

Clinical Predictors Of Driving Simulator Performance In Drivers With Multiple Sclerosis, Sarah Krasniuk

Electronic Thesis and Dissertation Repository

Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that may impact their fitness to drive. Fitness to drive is the ability to control a motor vehicle, as determined via a comprehensive driving evaluation, with in-clinic and on-road driving assessments. However, the on-road driving assessment may pose a crash risk to medically at-risk drivers. Instead, a driving simulator assessment that targets the driving performance deficits of drivers may inform fitness to drive decisions. However, utilizing clinical tests to indicate driving simulator performance in drivers with MS is not fully understood.

Through three aims, this dissertation will examine the clinical utility of …

Intimate Partner Violence (Ipv): Clinical And Societal Perspectives, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) can have a lasting impact on survivors’ emotional, physical, and psychological wellbeing. IPV is multifaceted and can influence survivors’ interactions across various institutions, including healthcare settings. This PhD project consists of both qualitative and quantitative studies aimed at exploring the clinical and societal perspectives around IPV.

Study #1 sought to explore the discourses around male IPV drawn from a social networking site (Reddit.com). While some areas related to IPV are well researched, studies on male intimate partner violence survivors are limited. The results from study #1 show that male IPV disclosure is a complex process. While …

The Experiences Of Female Adolescents Who Have Sustained A Concussion Through Sport Participation: A Consideration Of An Occupational Perspective During Recovery, Annalise Michelle Tichenoff

Electronic Thesis and Dissertation Repository

Adolescence is a time of rapid and tumultuous development in the physical, cognitive and psychosocial domains. Sustaining a concussion during this time period may complicate this development, particularly when symptoms are prolonged. Of particular importance is the study of adolescent females, as this population has been under-evaluated within the literature. This is especially troubling due to the number of concussions that occur among adolescent females, as concussions within this population reportedly occur at twice the frequency of adolescent males. This dissertation presents a qualitative case study investigation that explores the recovery experiences of adolescent female athletes who have sustained a …

Exploring Gender Equity Through Occupation: A Critical Decolonizing Ethnography In Tanzania, Stephanie Huff

Electronic Thesis and Dissertation Repository

Within the discipline of occupational science, scholars of increasingly diverse geographical spaces have highlighted the necessity of diversity and epistemological expansion to enact transformative scholarship. In response, this dissertation enacted a critical decolonizing ethnographic project with 5 women from Tanzania to explore their experiences of gender inequities.

This thesis is composed of four integrated manuscripts, as well as introduction and conclusion chapters. Manuscript two examines past perspectives and approaches to research which examined gender equity and inequity in Tanzania, illuminating gaps and recommendations for future gendered research in Tanzania. Manuscript three presents an argument for the uptake of Africana Womanism …

Optimizing Gait Outcomes In Parkinson's Disease With Auditory Cues: The Effects Of Synchronization, Groove, And Beat Perception Ability, Emily A. Ready

Electronic Thesis and Dissertation Repository

This dissertation explores a common, rehabilitative strategy for mitigating gait impairments in Parkinson’s disease (PD) called Rhythmic Auditory Stimulation (RAS). The effects of this intervention on gait in PD are well documented but highly variable, which poses difficulty for appropriate therapeutic application. Part of this variability may be related to individual musical abilities, such as beat perception accuracy, as most RAS interventions involve synchronizing with a beat. However, music is complex and variable. Therefore, factors inherent in the music itself may play a role in these differences, such as how much the music makes you want to move (groove), or …

"We Were Meant To Go Down One Road, But Now We Have Rerouted": A Phenomenological Inquiry Into The Experience Of Aging Out-Of-Place, Sachindri Wijekoon

Electronic Thesis and Dissertation Repository

In an age of globalization, the experience of aging in a foreign land is part of the late-life experience of many older adults. However, studies of aging and migration have largely failed to conceptualize the unique resettlement experiences of immigrants entering North America as older adults. This dissertation asked, “What is the experience of aging out-of-place?” Specifically, this research question aimed to understand how late-life immigrants relate to, and connect and engage with places through aging processes, and the essentiality of daily occupations within such engagement. An interpretive paradigm and a hermeneutic phenomenological methodology guided this inquiry. The hermeneutic phenomenological …

How Do Health Care Providers Identify And Address Lifestyle Factors With Community Dwelling Adults Who Have Chronic Wounds?, Linda Norton

Electronic Thesis and Dissertation Repository

Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups.

A common understanding of lifestyle factors was not …

Advancing Social Transformation Through Occupation: A Critical Examination Of Epistemological Foundations, Discourses And Contextual Factors Shaping Research And Practice, Lisette Farias Vera

Electronic Thesis and Dissertation Repository

Widespread appeals to advance a social justice agenda have emerged within health-related fields. However, expressing a commitment to social justice has created tensions within occupational science and therapy as scholars attempt to enact social transformative scholarship while at the same time having roots within health sciences, a field largely dominated by positivist/postpositivist thinking. The broader intent of this thesis is to inform further development of occupation-based social transformative scholarship aligned with the critical paradigm.

This doctoral dissertation is comprised of five integrated manuscripts, in addition to introduction and discussion chapters. Chapter two examines the increasing use of critical perspectives and …

Links Between Physical And Mental Health: Assessment Of Therapeutic Riding’S Effect On Children With Special Needs, Sabah I. Hasan

Brescia Psychology Undergraduate Honours Theses

This observational study examined the effect of therapeutic riding (TR) on four domains, physical skills, positive values, social skills, and self-identity in children with special needs. Participants were recruited from SARI Therapeutic Riding and were divided, based on observation, into more or less severe diagnosis categories. It was predicted that children with less severe diagnosis would show more of an increase on the four domains, especially physical skills due to TR. Participants were observed using an observational checklist at pre- and post-riding lessons. Results showed non-significant differences in all four domains, however, there was a tendency for scores to increase …

Optimizing The Composition And Delivery Of Assessment And Treatment Following Distal Radius Fracture, Michael L. Szekeres

Electronic Thesis and Dissertation Repository

Distal radius fracture (DRF) is the most common fracture.¹ The most recent Cochrane review indicated “The available evidence from randomized controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius”.²

Since the relative effectiveness of the various interventions used for rehabilitation after DRF is unknown, the main goal of this thesis is to focus on one aspect of both assessment and treatment to add to the current literature base. The first paper (Chapter 2) describes a new method using a modified finger goniometer …

Fitness-To-Drive Screening Measure© : Constructing And Validating The Short Form, Shabnam Medhizadah

Electronic Thesis and Dissertation Repository

The valid and reliable Fitness-to-Drive Screening Measure^© (FTDS) is a free online proxy measure that screens for at-risk older drivers using 54 driving-related items. This secondary data analysis aims to construct and validate a short form FTDS, using 200 caregiver FTDS response sets and 200 older driver on-road assessment pass/fail outcomes. To construct the short form, exploratory factor analysis and classical test theory techniques were employed to determine the most interpretable factor model and the minimum number of items that might be used to predict fitness to drive. Next, receiver operating characteristics curves were generated to evaluate the concurrent …

An Evaluation Of The Effectiveness Of A Simulated Classroom-Based Intervention On Concussion Rehabilitation Among Individuals With Persistent Post-Concussion Symptoms, Bedoor Alqenai

Electronic Thesis and Dissertation Repository

Although recent clinical and scientific effort has focused on the development of guidelines for post-concussion return to play/work/learn, there is still relatively little literature that addresses specific treatment methods by which this can be accomplished. Accordingly, this study investigated the effect of a 7-week simulated classroom-based intervention on the self-reporting of symptom scores among 71 individuals with persistent concussion symptoms (26 men and 45 women). All participants were provided with novel strategies for reading, writing, study skills, social communication and technology use. Self-assessment of symptoms were obtained weekly, both before and after each session of the treatment program, in an …

Optimizing The Rehabilitation Of Elbow Lateral Collateral Ligament Injuries, Ranita Harpreet Kaur Manocha

Electronic Thesis and Dissertation Repository

Elbow lateral collateral ligament (LCL) injuries frequently arise following trauma, and can result in disabling instability. Typically such injuries are managed with immobilization followed by a graduated exercise regime; however there is minimal biomechanical evidence to support current treatment protocols. This investigation examines the in vitro effectiveness of several rehabilitation techniques using a custom elbow motion simulator. It was found that active range of motion is safest in the overhead position (n = 7). Early motion in this position may reduce the incidence of elbow stiffness without compromising ligament healing following LCL injury. Forearm pronation and active motion stabilize …

Concept Mapping And The Cognitive Orientation To Daily Occupational Performance (Co-Op) Approach As An Intervention Framework For Adolescents With Autism Spectrum Disorder (Asd), Jessie A. Wilson

Electronic Thesis and Dissertation Repository

Individuals who are diagnosed with Autism Spectrum Disorder (ASD) experience a range of difficulties that impact their daily occupational performance. The current body of research identifies the importance of occupational engagement and competence as fundamental elements in facilitating an individual’s social connections, development of personal autonomy and overall wellbeing. This dissertation explores the use of concept mapping embedded within the meta-cognitive framework of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach, to engage adolescents with ASD in meaningful occupations.

This thesis contains three manuscripts, an introductory and a final reflection chapter. The first manuscript is a methodological paper that …

Examination Of The Usability Of The Ipad Among Older Adult Consumers, Mike J. Voumvakis

Electronic Thesis and Dissertation Repository

Background and Purpose

In the current technological-era there is assumption of universal Internet access of citizens in North America. Many senior citizens have the desire to access the Internet, however have limited experience-using computers. There currently exists multiple options in addition to personal computers to access the Internet such as tablet computers, however there has been limited research performed on the use of these technologies by senior citizens.

Methodology and Methods

This paper describes the experiences and insight of five novice senior iPad owners as well as a detailed task and activity analysis of these seniors utilizing the device. Through …

Managing Uncertainty In Young-Onset Parkinson's Disease, Michael J. Ravenek

Electronic Thesis and Dissertation Repository

Typically considered a disease of old-age, Parkinson’s disease can affect those younger in life, i.e., before the age of 55, when it is referred to as young-onset Parkinson’s disease (YOPD). Using constructionist grounded theory, this research sought to understand how, and why, individuals with YOPD became informed about their disease over time. A total of 39 individuals, who self-identified as living with YOPD, took part in this study which was organized according to four cycles of data collection. These cycles utilized focus groups, in-depth interviews and a private online discussion board, supplemented by 14 autobiographies written by individuals living with …

From Their Perspective: How Adolescents And Young Adults Experience And Conceptualize Life And Occupation Surrounding Parental Divorce Or Separation, Laura R. Hartman

Electronic Thesis and Dissertation Repository

Parental divorce affects adolescents’ emotions, routines, habits, occupations and relationships. The current body of research indicates that parental divorce leads to many unfavourable social, behavioural, and mental health outcomes for adolescents. This dissertation explores the daily lives and occupations of adolescents and young adults surrounding the transition of a parental divorce or marital separation.

This thesis contains four manuscripts in addition to the introductory and final reflection chapters. The first manuscript explores the current North American literature relating to adolescent life surrounding a parental divorce or marital separation, ranging form 1998 to 2014. The second manuscript provides an overview of …

Resting State Functional Magnetic Resonance And Diffusion Tensor Imaging Of Hemiplegic Cerebral Palsy Patients Treated With Constraint-Induced Movement Therapy: Predictors And Clinically Correlated Evidence Of Neuroplasticity, Kathryn Y. Manning

Electronic Thesis and Dissertation Repository

Hemiplegic cerebral palsy is characterized by unilateral upper limb impairment and patients often compensate by performing most tasks with their unaffected arm. Constraint-induced movement therapy (CIMT) directly combats this learned non-use by casting the unaffected arm and forcing the patient to repetitively practice skills with the hemiplegic limb. Subjects with hemiplegic cerebral palsy were recruited from Holland Bloorview Kids Rehabilitation Hospital, Thames Valley Children’s Centre and McMaster Children’s Hospital. MRI acquisitions and clinical evaluations were collected at baseline, 1 and 6-months later. The case group participated in a CIMT camp after baseline evaluations and was compared to an untreated control …

Examining The Shift In Occupational Identity After A Brain Injury, Mikelle Bryson-Campbell

Electronic Thesis and Dissertation Repository

Occupational identity is defined by Kielhofner (2002) as a sense of who we are as an occupational being, based on our past, current, and future occupational roles. When a life disruption occurs such as a brain injury (BI) and the disruption impacts the ability to conduct an occupation deemed meaningful an important process of transition occurs (Muenchberger, Kendall, & Neal, 2008). In turn occupational identity may shift to reflect the current health and economic status of the individual and what occupations are judged as meaningful.

The current study examined the shift in occupational identity in BI survivors in a two …