Medicine and Health Sciences Commons^™

The Child And Adolescent Scale Of Environment (Case): Further Validation With Youth Who Have Chronic Conditions, Gary Bedell, Janette Mcdougal

Occupational Therapy Publications

Objective: To further validate the Child and Adolescent Scale of Environment (CASE).

Methods: Baseline data (n = 430) were analyzed from a longitudinal study on quality of life for youth with chronic conditions ages 11–17 in Ontario, Canada. Internal consistency and structure, and convergent and discriminant validity were examined via Cronbach’s alpha (α), exploratory factor analyses, correlation analyses and ANOVA.

Results: The CASE had high internal consistency (α = 0.89). A three-factor solution was produced with 55% variance explained: (1) Community/Home Resources, (2) School Resources and (3) Physical Design/Access). CASE total and factor …

A Review Of Transcranial Magnetic Stimulation And Multimodal Neuroimaging To Characterize Post-Stroke Neuroplasticity, Angela M. Auriat, Jason L. Neva, Sue Peters, Lara A. Boyd

Physical Therapy Publications

Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity) both spontaneously and with the aid of behavioral rehabilitation and non-invasive brain stimulation. Multiple neuroimaging techniques can characterize common structural and functional stroke-related deficits, and importantly, help predict recovery of function. Diffusion tensor imaging (DTI) typically reveals increased overall diffusivity throughout the brain following stroke, and is capable of indexing the extent of white matter damage. Magnetic resonance spectroscopy (MRS) provides an index of metabolic changes in surviving neural tissue after stroke, serving as a marker of brain function. The neural …

Inter-Rater Reliability Of The Mckenzie System Of Mechanical Diagnosis And Therapy In The Examination Of The Knee, Sean Willis

Electronic Thesis and Dissertation Repository

Objective: The purpose of this thesis was to investigate the inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy (MDT) when classifying patients with musculoskeletal knee pain using clinical vignettes. Methods: This study was divided into two phases. First, ten clinicians experienced in the use of MDT were randomly recruited to write a total of 60 clinical vignettes based upon the initial assessment of past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. Results: There was “substantial agreement” among six MDT raters …

Maternal Factors And The Emotional And Behavioural Functioning Of Adolescents With Chronic Health Conditions, Nicole Etherington, Janette Mcdougall, David Dewit, Virginia Wright

Occupational Therapy Publications

Purpose: This study investigated the association between mothers’ mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time.

Methods: Data were drawn from an ongoing study. Study participants (N¼363) were recruited through eight children’s rehabilitation centres. Logistic regression models were estimated.

Results: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR¼0.10; p50.01). Where low maternal education was present, girls were more likely to display peer relationship problems one year later (OR¼3.72; …

Motor And Visuospatial Attention And Motor Planning After Stroke: Considerations For The Rehabilitation Of Standing Balance And Gait, Sue Peters, Todd C. Handy, Bimal Lakhani, Lara A. Boyd, S. Jayne Garland

Physical Therapy Publications

Attention and planning can be altered by stroke, which can influence motor performance. Although the influence of these factors on recovery from stroke has been explored for the upper extremity (UE), their impact on balance and gait are unknown. This perspective article presents evidence that altered motor and visuospatial attention influence motor planning of voluntary goal-directed movements poststroke, potentially affecting balance and gait. Additionally, specific strategies for rehabilitation of balance and gait poststroke in the presence of these factors are discussed. Visuospatial attention selects relevant sensory information and supports the preparation of responses to this information. Motor attentional impairments may …

A Randomized Clinical Trial To Compare The Effect Of Non Operative Treatment With And Without Autologous Conditioned Plasma (Acp) On Healing And Function In Patients With Achilles Tendon Ruptures, Tyler M. Pratt

Electronic Thesis and Dissertation Repository

The purpose of this study was to determine whether there is evidence to support conducting a larger randomized control trial (RCT) to compare the non-operative treatment of Achilles tendon (AT) ruptures with or without Autologous Conditioned Plasma (ACP®). Twenty-four patients were randomized to receive an ACP® or saline injection within seven days and again at two weeks post-rupture. Tendon healing was longitudinally evaluated using ultrasound (US) and magnetic resonance imaging (MRI). Functional and patient-reported quality of life measures were also assessed. A small sample size limited our ability to detect statistically significant differences. The mean rankings of healing were slightly …

Degrees Of Damage: Quantifying Male Vs. Female Exercise-Induced Muscle Damage Through Magnetization Transfer Ratios, Nicholai Michael Clausius Crawford

Electronic Thesis and Dissertation Repository

No direct, quantitative, and non-invasive markers presently exist to assess exercise-induced muscle damage (EIMD). However, magnetization transfer ratios (MTR), an emerging measurement quantified via magnetic resonance imagery, provide more direct indication of muscle integrity following EIMD. This study compares and correlates the temporal pattern of the MTR to alternative indirect markers of EIMD in male vs. female populations, and subsequently establishes whether there are sex differences in biochemical activity during recovery. The antioxidant properties of estrogen hypothetically minimize muscle trauma, maintain membrane stability, and limit swelling resulting in heightened tissue integrity and resilience to EIMD. Six males and three females …

Mobility And Cognition In Seniors. Report From The 2008 Institute Of Aging (Cihr) Mobility And Cognition Workshop, Manuel Montero-Odasso, Louis Bherer, Stephanie Studenski, Karen Gopaul, Afua Oteng-Amoako, Sarah Woolmore-Goodwin, Paul Stoole, Jennie Wells, Timothy Doherty, Aleksandra A. Zecevic, David Galinsky, R. Jane Rylett, Jeffrey Jutai, Susan W. Muir-Hunter, Mark Speechley, Richard Camicioli

Physical Therapy Publications

Background

The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop.

Methods

Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors.

Results

Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research …

Prevalence And Influences Of Preschoolers’ Sedentary Behaviors In Early Learning Centers: A Cross-Sectional Study, Patricia Tucker, Leigh M. Vanderloo, Shauna M. Burke, Jennifer D. Irwin, Andrew M. Johnson

Occupational Therapy Publications

Background

Recent research has highlighted the need for increased evidence regarding the sedentary activity levels of preschoolers. Given the large proportion of time this population spends in various early learning facilities, the exploration of sedentary behaviors within this particular environment should be a priority. The purpose of the study was two-fold: (1) to compare sedentary time of preschoolers in three different early learning environments (i.e., full-day kindergarten [FDK], center-, and home-based childcare); and (2) to assess which characteristics (i.e., staff behaviors, sedentary environment, fixed play environment, portable play environment, sedentary opportunities) of these early learning environments influence preschoolers’ sedentary time. …

Measurement Of Illness Perception And Behaviour Along A Continuum Of Symptomatic Knee Osteoarthritis: A Transdisciplinary Approach, Clayon B. Hamilton

Electronic Thesis and Dissertation Repository

Objectives: A multifactorial approach is recommended for the identification/diagnosis, prognosis, and treatment of pain in knee osteoarthritis (OA). One aspect of this approach includes illness perception and behaviour. The purpose of this thesis was to investigate the measurement of illness perception and behaviour along a continuum of symptomatic knee OA, starting from the early symptoms of knee OA.

Methods: Three studies were conducted to fulfill this purpose. The first study was a scoping review that applied an interpretative analysis to validated measures that had been used to assess people with knee pain and/or knee OA. Second was the construct validation …

Stability Study: A Multicentre Rct Comparing Acl Reconstruction With And Without Lateral Extra-Articular Tenodesis For Individuals At High Risk Of Graft Failure, Christopher Eric Hewison

Electronic Thesis and Dissertation Repository

Seventy patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomly assigned to receive ACLR alone or ACLR plus a lateral extra-articular tenodesis (LET). Our primary outcome was Limb Symmetry Index (LSI) calculated using a series of four hop tests at six months postoperative. Secondary outcomes measures included pain, subjective function and isokinetic strength testing. We found no statistically significant difference between the two groups in LSI calculations. We found statistically significant differences favouring the ACLR alone group in quadriceps average power and peak torque symmetry measurements at six-months postoperative when we adjusted for baseline measurements. No other statistically significant …

Development Of A Wearable Mechatronic Elbow Brace For Postoperative Motion Rehabilitation, Anastasiia Kyrylova

Electronic Thesis and Dissertation Repository

This thesis describes the development of a wearable mechatronic brace for upper limb rehabilitation that can be used at any stage of motion training after surgical reconstruction of brachial plexus nerves. The results of the mechanical design and the work completed towards finding the best torque transmission system are presented herein. As part of this mechatronic system, a customized control system was designed, tested and modified. The control strategy was improved by replacing a PID controller with a cascade controller. Although the experiments have shown that the proposed device can be successfully used for muscle training, further assessment of the …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

Reliability Of The Berg Balance Scale As A Clinical Measure Of Balance In Community-Dwelling Older Adults With Mild To Moderate Alzheimer Disease: A Pilot Study, Susan W Muir-Hunter, Laura J. Graham, Manuel Montero Odasso

Physical Therapy Publications

Purpose : To measure test-retest and interrater reliability of the Berg Balance Scale (BBS) in community-dwelling adults with mild to moderate Alzheimer disease (AD).

Method : A sample of 15 adults (mean age 80.20 [SD 5.03] years) with AD performed three balance tests: the BBS, timed up-and-go test (TUG), and Functional Reach Test (FRT). Both relative reliability, using the intra-class correlation coefficient (ICC), and absolute reliability, using standard error of measurement (SEM) and minimal detectable change (MDC95) values, were calculated; Bland-Altman plots were constructed to evaluate inter-tester agreement. The test-retest interval was 1 week.

Results : For the BBS, relative …

Quantifying The Effects Of Systematic Stn-Dbs Programming On Rest And Postural Tremor In Idiopathic Parkinson Disease Patients, Kristina Ognjanovic

Electronic Thesis and Dissertation Repository

Parkinson’s disease (PD) is a complex neurodegenerative disorder that encompasses both motor and non-motor symptoms. These symptoms and their severity are typically assessed by scale based measures in a clinical setting. Scale- based assessments of PD patients undergoing bilateral subthalamic nucleus deep brain stimulation surgery (STN-DBS) such as the Unified Parkinson Disease Rating Scale (UPDRS) are commonly used in a clinical setting to assess symptom severity and progression. However, the subjective nature of these and other clinical scales call into question both the sensitivity and accuracy of patient assessment over time. An objective quantification of rest and postural tremor of …

The Healthy Mind, Healthy Mobility Trial: A Novel Exercise Program For Older Adults, Dawn P. Gill, Michael A. Gregory, Guangyong Zou, Teresa Liu-Ambrose, Ryosuke Shigematsu, Vladimir Hachinski, Clara Fitzgerald, Robert Petrella

Lifestyle Research Team

BACKGROUND:

More evidence is needed to conclude that a specific program of exercise and/or cognitive training warrants prescription for the prevention of cognitive decline. We examined the effect of a group-based standard exercise program for older adults, with and without dual-task training, on cognitive function in older adults without dementia.

METHODS:

We conducted a proof-of-concept, single-blinded, 26-wk randomized controlled trial whereby participants recruited from preexisting exercise classes at the Canadian Centre for Activity and Aging in London, Ontario, were randomized to the intervention group (exercise + dual-task [EDT]) or the control group (exercise only [EO]). Each week (2 or 3 …

Perception Of Fatigue In Individuals Diagnosed With Head And Neck Cancer, Grace Scott

Electronic Thesis and Dissertation Repository

Head and neck cancer (HNCa) presents numerous challenges secondary to treatment. While there is substantial clinical awareness to the range of challenges demonstrated in this population, information on the impact of fatigue in recovery and rehabilitation is limited. This study investigated the degree of perceived fatigue in those treated for HNCa. The study was a cross-sectional, self-report, survey design. Adult participants (n=55) completed a series of four validated questionnaires. Two validated measures specific to fatigue (FSI and MFI-20) and two quality of life measures (EORTC-QLQ-C30 and EORTC-QLQ-H&N35) were administered. Correlational analysis revealed an inverse relationship between fatigue and measures of …

Reliability Of Three Landmarking Methods For Dual Inclinometry Measurements Of Lumbar Flexion And Extension, Joy C. Macdermid, Vanitha Arumugam, Joshua I. Vincent, Kimberly L. Payne, Aubrey K. So

Health and Rehabilitation Sciences Publications

Background

To examine the intra and inter-rater reliability of lumbar flexion and extension measurements attained using three landmarking methods for dual inclinometry.

Methods

This was a repeated measures reliability study. Convenience sampling was used to obtain forty volunteer subjects. Two assessors measured a series of lumbar flexion and extension movements using the J-Tech™ dual inclinometer. Three different landmarking methods were used: 1) straight palpation of PSIS and L1, 2) palpation of PSIS and the site of the nearest 5 cm interval point closest to L1 and 3) location of PSIS and 15 cm cephalad. Upon landmarking, adhesive tape was used …

The Physical Activity Levels And Sedentary Behaviors Of Latino Children In London (Ontario, Canada), Gillian E. Mandich, Shauna Burke, Anca Gaston, Patricia Tucker

Health and Rehabilitation Sciences Publications

OBJECTIVE: To assess the physical activity and sedentary behaviors of a sample of Latino children in London, Ontario, Canada.

METHODS: Seventy-four Latino children (54.1% male; mean age = 11.4) completed self-report questionnaires related to physical activity and sedentary behaviors. A subset of children (n = 64) wore Actical (Mini Mitter, Respironics) accelerometers for a maximum of four days.

RESULTS: Latino children self-reported moderate levels of physical activity (i.e., mean score of 2.8 on 5-point scale). Accelerometer data revealed that children spent an average of 50.0 min in moderate-to-vigorous physical activity (MVPA; 59.2 min on weekdays and 50.6 min on weekend …

Careful, Not Fearful: A Mixed Methods Study To Investigate Fall-Risk Appraisal And Fear Of Falling In Community-Dwelling Older Adults, P. Karen Simmavong

Electronic Thesis and Dissertation Repository

This study investigated older adult’s accuracy in fall-risk judgement and ascertained whether fall-risk appraisal was situation specific or general in nature. Convenience and snowball sampling were used to recruit 30 community-dwelling older adults aged 65 years and older. An embedded correlational mixed methods was utilized to investigate relative and absolute fall-risk judgement, balance confidence, and hazard identification. Using Pearson Product Moment correlations, multiple regressions, and qualitative analysis, the findings suggest older adults are not always accurate in appraising fall-risk. Judgements were specific and not general in nature, as only 9.30% of variance in risk appraisals and 12.96% of variance in …

Take 2 Steps And Call Me In The Morning: Prescribing Physical Activity Through Primary Care, Emily Knight

Electronic Thesis and Dissertation Repository

Objectives: Physical activity guidelines for older adults target high-intensity activities (i.e. increasing exercise), with less attention on low-intensity activities (i.e. reducing/interrupting sedentary behaviours) to improve health. Mobile health (mHealth) holds promise for engaging patients in self-management of chronic diseases. The purpose of this research was to prescribe physical activity of various intensities (i.e. sedentary through exercise) in primary care paired with mHealth for self-management.

Methods: 60 older adults (55-75yr) were randomly assigned to four groups: one control, and three receiving mHealth kits plus prescription for a specific intensity of physical activity (exercise, sedentary or both). Clinical measures (anthropometrics, …

Characterizing Knee Loading Patterns In People Post-Stroke, Stephanie Marrocco

Electronic Thesis and Dissertation Repository

Post-stroke temporal gait asymmetry (TGA) could cause excess loading of the non-paretic leg which may cause musculoskeletal (MSK) issues in the knee. This thesis investigated knee loading during gait and its relationship to TGA post-stroke. Methods: Gait analysis was conducted in nine people post-stroke. Gait was classified as symmetric (TGS) or asymmetric and external knee adduction (KAM) and flexion moments (KFM) were calculated. Participants were compared to healthy older adults (n=109) on KAM and KFM. The proportion of individuals with increased loading was compared between the TGS and TGA groups. Results: Six and four participants exhibited increased loading …

Mirror Therapy For The Lower-Extremities Post-Stroke, Lucas David Crosby

Electronic Thesis and Dissertation Repository

Despite extensive rehabilitation post-stroke gait remains slow, variable and asymmetric. There is a need for simple interventions to improve lower-extremity motor control and walking ability. Mirror therapy is a promising intervention though little attention has focused on its use on the lower-extremities post-stroke. This thesis investigates the feasibility and potential effects of a bilateral lower-extremity mirror therapy intervention (LE-MT) post-stroke. A case series involving three participants, who performed twelve 30 minute sessions of LE-MT over four weeks, is presented. Session duration and number of repetitions completed improved over the course of the intervention indicating LE-MT post-stroke is feasible. Some cases …

Reverse Innovation: An Opportunity For Strengthening Health Systems, Anne W Snowdon, Harpreet Bassi, Andrew D. Scarffe, Alexander D Smith

Health and Rehabilitation Sciences Publications

BACKGROUND: Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada.

METHODS: An open call for applications took place over a 4-month period. Applicants …

Short-Term Cortical Plasticity Associated With Feedback-Error Learning After Locomotor Training In A Patient With Incomplete Spinal Cord Injury, Amanda E. Chisholm, Sue Peters, Michael R. Borich, Lara A. Boyd, Tania Lam

Physical Therapy Publications

Background and purpose: For rehabilitation strategies to be effective, training should be based on principles of motor learning, such as feedback-error learning, that facilitate adaptive processes in the nervous system by inducing errors and recalibration of sensory and motor systems. This case report suggests that locomotor resistance training can enhance somatosensory and corticospinal excitability and modulate resting-state brain functional connectivity in a patient with motor-incomplete spinal cord injury (SCI).

Case description: The short-term cortical plasticity of a 31-year-old man who had sustained an incomplete SCI 9.5 years previously was explored in response to body-weight-supported treadmill training with velocity-dependent resistance applied …

Youth With Disabilities Talk About Spirituality: A Qualitative Descriptive Study, Patricia J. Baldwin, Jan Evans, Nicole Etherington, Megan Nichols, Viginia Wright, Janette Mcdougall

Occupational Therapy Publications

There is little known about what spirituality means for youth with disability or about the potential relevance of youths’ spirituality in pediatric rehabilitation. This study explored perceptions of spirituality for youth with disabilities. Using a qualitative descriptive methodology, we examined the lived experiences of eighteen youth ages 11-20 years with disabilities including cerebral palsy, central nervous system disorder or autism spectrum disorder. In individual interviews, followed by a focus group, youth identified key spiritual themes – the importance of their beliefs, personal sources of comfort and strength, finding purpose in helping others, significance of personal connections, and strengths-based perspectives on …

Quality Of Life And Self-Determination: Youth With Chronic Health Conditions Make The Connection, Janette Mcdougall, Patricia Baldwin, Jan Evans, Megan Nichols, Nicole Ehterington, Virginia Wright

Occupational Therapy Publications

While optimizing quality of life(QOL) is a key goal of rehabilitation care,no previous study has reported on what ‘QOL’ means to youth with chronic health conditions. In addition, no qualitative studies have explored the relationship between QOL and self-determination(SD). Objectives of this qualitative study were to examine: what the terms ‘quality of life’ and ‘self-determination’ mean to youth with chronic conditions; the factors these youth think are linked with these concepts; the relationship they see between concepts, the types of future goals youth have and how they view the connection between their SD and these goals. A descriptive methodology was …

Situating Occupation In Social Relations Of Power: Occupational Possibilities, Ageism And The Retirement ‘Choice’, Debbie Laliberte Rudman

Occupational Therapy Publications

Introduction: Research attending to social relations of power can enhance understanding of the mechanisms through which occupational injustices occur and inform socially transformative practice. This study explored how power operates through ageism in ways that shape what people come to take for granted regarding occupation in relation to age, and what occupations are supported through socio- political conditions.

Methods: Narratives were collected using a two-stage interview process with 17 retired Canadians. A critical narrative analysis approach was employed to examine how these narratives revealed the complex ways occupations are negotiated within broader discourses and age relations.

Findings: Ageism mattered for …

The Manual Ability Classification System: A Scoping Review, Deepa Jeevanantham, Emily Dyszuk, Doreen Bartlett

Physical Therapy Publications

PURPOSE: To examine the use of the Manual Ability Classification System (MACS) and to identify gaps in the literature by conducting a thorough search of existing publications from 2006 to March 2013.

METHODS: An extensive literature search included 15 databases, using the search terms "Manual Ability Classification System" or "MACS" to retrieve relevant abstracts.

RESULTS: A total of 161 articles were identified for final inclusion. The review identified literature that supports the reliability, validity, and stability of the MACS.

CONCLUSIONS: The MACS could be considered as a standard classification for children with cerebral palsy on the basis of manual abilities. …