Early Neuromuscular Stimulation And Mirror Therapy Interventions To Prevent Functional Loss During Immobilization Of Distal Radius Fractures, Stephanie Reischl Rmt, Pt

Electronic Thesis and Dissertation Repository

Introduction: Mirror therapy (MT) and neuromuscular electrical stimulation (NMES) are interventions that mitigate impairments in pain, strength, range of motion (ROM), and function. Immobilization to treat distal radius fractures (DRF) can result in similar impairments. MT and NMES can be applied during immobilization for DRF as they do not require active movement of the affected extremity. This is the study to investigate the feasibility of in-home MT, NMES, MT+NMES interventions during the immobilization period for DRF.

Methods: Literature reviews were conducted to determine how NMES and MT have been used with musculoskeletal conditions. In-home MT, NMES, and MT+NMES interventions were …

Exploring The Effect Of Combining Repetitive Transcranial Magnetic Stimulation With Functional Electrical Stimulation Cycling On Lower Extremity Function Following Incomplete Spinal Cord Injury, Fereshteh Ghahremani

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Spinal cord injury (SCI) is a neurological condition that disrupts lower extremity function, limiting mobility and independence. This dissertation explores the feasibility, acceptability, and safety of combining repetitive transcranial magnetic stimulation (rTMS) with functional electrical stimulation (FES) cycling to improve lower extremity function following motor incomplete SCI (iSCI). This study is a case series pilot study in which participants with iSCI underwent a combined protocol of rTMS and FES cycling for six weeks. The results demonstrate the preliminary feasibility, participant acceptability, and safety of combining rTMS and FES cycling. While results varied between participants, one participant showed improvements in walking …

Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan

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Patient-centered care (PCC) is a growing standard for healthcare delivery due to the benefits to patient autonomy. Lacking a cohesive definition in the physiotherapy literature, it is also lacking in implementation. Employing interpretive description with semi-structured interviews, the goal was to understand how physiotherapists drawn from private for-profit clinics in Canada describe PCC, and barriers and facilitators to providing it. Results included requiring person-centered communication in PCC, seeing Health holistically, centering the patient in care, and being a skill that becomes clearer with practice experience. Barriers included: lack of practitioner reflexivity, patient not desiring self-directed care, and limited access to …

Development And Validation Of The Pain Resilience And Optimism Scale (Pros), Wonjin Seo

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Numerous self-report questionnaires have been used in pain research to explore patients' experiences. However, these questionnaires often employ negatively worded items that can potentially worsen patients' distress. In response to the emergence of positive psychology, this thesis aimed to develop a new questionnaire that adopts a positive and strengths-focused approach, incorporating resilience, to replace the negative items found in existing tools such as the Pain Catastrophizing Scale (PCS). First, the effectiveness of the Connor-Davidson Resilience Scale (CD-RISC) in measuring resilience following trauma was assessed through a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments …

Combined Interdisciplinary Rehabilitation For Persisting Symptoms Following A Mild Traumatic Brain Injury, Marquise Morrissey

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Mild traumatic brain injuries (mTBI’s) are the most frequently experienced form of traumatic brain injury. Certain demographic characteristics, including older age, female sex, and pre-existing mental health conditions, increase the risk of experiencing persisting symptoms beyond the acute injury phase. Care for individuals with an mTBI is limited by geography, non-standardized trajectories of care, and gaps in healthcare provider knowledge. An interdisciplinary outpatient intervention has been created to address these issues, but has not been evaluated. Accordingly, the overall purpose of this thesis was to investigate treatment outcomes of individuals with persisting symptoms following an mTBI after completing a combined …

Evaluation Of Conservative And Operative Treatments In Active Patients With Acromioclavicular (Ac) And Rotator Cuff (Rc) Injuries, Jesse Singh

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Abstract

Introduction: Shoulder pain and disability, particularly acromioclavicular joint (ACJ) and rotator cuff (RC) injuries, are common in a physically active population. Determining operative or rehabilitative treatment plans involve multiple treatment choices influenced by the injury grade and treatment goals, such as return to sport. This thesis investigates the management of treatment for AC and RC injuries

Method: The first study is a scoping review that uses the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) to synthesize 32 studies involving athletes who have undergone conservative or operative treatment for their Rockwood grade III …

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

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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 …

A Community Dweller’S Perspective Of A Day Shoulder Arthroplasty Surgery., Bansari D. Patel Ms.

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The following study was a qualitative interpretive descriptive study aimed at investigating immediate barriers or difficulties in the lives of the community dwellers as well as modifications occurring in the daily routine activities shortly after the out-patient total shoulder arthroplasty procedure. The personal and surgical factors affecting at-home recovery were focussed alongside exploring the coping mechanisms and adaptations in everyday day life. The study mainly focused on the initial three weeks' duration after the discharge. The study followed the constructivist paradigm, adopting the interpretive description methodology. A total of 19 subjects who underwent same/ single day discharge total shoulder arthroplasty …

Exploring The Relationship Between Hemispheric Prefrontal Cortex Activation, Standing Balance, And Fatigue In Individuals Post-Stroke: A Fnirs Study, Sarthak Kohli

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Balance impairments are common after stroke. Reasons for this are multifactorial and include motor dysfunction and fatigue. Limited research has explored the combined effects of post-stroke fatigue and balance on brain activation patterns. Research has shown that prefrontal cortex (PFC) activation may be involved in both motor control and fatigue throughout the recovery process post-stroke. The aim of this thesis was to determine whether: (1) PFC activation levels change between standing balance tasks, (2) PFC hemispheric activation is asymmetric during standing balance tasks, and (3) fatigue levels are associated with task-based activation. Patients with hemiparesis were recruited from the inpatient …

Depression As A Prognostic Factor For Lumbar Spinal Stenosis Outcomes, Ariel M. Morales

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Lumbar spinal stenosis (LSS) is a degenerative disease common in older adults and is associated with significantly reduced health-related quality of life and increased disability. Depression has been found to be associated with poorer health-related outcomes in patients with spinal conditions. A systematic review was conducted to examine the literature regarding the prognostic value of depression for LSS outcomes. Findings suggest small to moderate prognostic value of depressive symptoms for postoperative outcomes in patients with LSS, with strong evidence for disability. Next, a secondary analysis of a cohort study was conducted to investigate two objectives. The first objective was to …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

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One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

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

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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 …

Investigation Of Exercise, Nutrition, And High Tibial Osteotomy Interventions For Patients With Medial Dominant Knee Osteoarthritis, Codie Primeau

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Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO).

Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported …

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

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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. …

Exploring The Inter-Relationship Between Cognitive And Motor Function In People With Lower Limb Amputations, Humberto Adolfo Omaña Moreno

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The main objective of the present dissertation was to expand our understanding of the inter-relationship between cognition and mobility in people with lower limb amputations (PLLA). Study 1 systematically reviewed the literature to assess the effects of dual-task testing on the balance and gait of PLLA. A total of twenty-two studies were included. Overall, PLLA demonstrated a disproportionately greater dual-task effect than controls, characterized by increased sway velocity and reduced pace and rhythm, and increased asymmetry when balance or walking was paired with a secondary task. Additionally, the dual-task effect was not influenced by differences in etiology, level of amputation, …

Advancing Type 2 Diabetes As A Condition For Primary Referral To Physiotherapy In Canada, Sarah M. Janssen

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Obesity and sedentary lifestyle are increasingly prevalent risk factors for type 2 diabetes (T2D), characterized by high blood glucose levels. Adoption and maintenance of healthy eating, physical activity, and exercise is recommended for lowering blood glucose and weight management. Physiotherapists are experts in prescribing safe, effective exercise to optimize health for people with co-morbid health conditions. However, T2D is not a primary condition for referral to physiotherapy services in Canada. The overall question guiding a series of three related studies was, What is the current education and perspectives of Canadian physiotherapists about their role in managing T2D? Study one surveyed …

The Genetics Of Pain: An Exploration Of Gene-By-Environment Interactions And Their Effects On Pain, Mohamad F. Fakhereddin

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The findings presented in this dissertation are part of the bigger SYMBIOME project which aims to use the biopsychosocial model of pain to develop a prognostic clinical phenotype for people that experience musculoskeletal (MSK) trauma. Chapter 2 presents an exploratory analysis to assess the relationships between genetic polymorphisms and pain severity and interference. Early childhood trauma was also explored as a moderator between genetic polymorphisms and pain outcomes. For pain severity, major allele carriers (A/A and G/A) of FKBP5 rs9394314 reported significantly higher scores than minor allele carriers (G/G). Further, major allele carriers who had at least one adverse childhood …

Consideration Of Executive Functioning For Physiotherapy Rehabilitation: Studies Of Physiotherapists’ Knowledge, Normative Data, And A Practice Application, Nicole A. Guitar

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Executive functioning (EF) refers to cognitive abilities involved in decision-making and self-regulation and can be impaired in many patients referred for physiotherapy, including older adults and people living with chronic pain. This dissertation aimed to determine what physiotherapists understood about EF, to summarize normative data for application in physiotherapy practice, and to provide an assessment of feasibility for studying EF impairments in people living with chronic pain. Study one surveyed what physiotherapists understood about EF as a concept, what EF assessments they used, and if this was influenced by their primary area of practice. Respondents (N = 262) subjectively reported …

Femoroacetabular Impingement Syndrome: Evaluating Postoperative Rehabilitation Progress And Return To Sport Readiness, Trevor A. Day

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Femoroacetabular impingement syndrome (FAIS) is a common cause of non-arthritic hip pain and reduced physical activity in active young adults. It is defined as a motion-related disorder of the hip with a triad of symptoms, clinical signs, and imaging findings that represents symptomatic premature contact between the proximal femur and the acetabulum. There are two anatomical morphologies that can cause FAIS, cam, and pincer, and is a challenging clinical pathology. Patients typically undergo hip arthroscopy to repair damage to the joint and recess the bone causing the impingement. These procedures can result in positive outcomes for the patient, like reduced …

A Transformative Journey: The Lived Experience Of Healthcare Learners Participating In Pain Management Education, Zoe A. Leyland

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There is little emphasis on pain management education for healthcare providers. In September 2019, the Master of Clinical Science (MClSc) program in Advanced Healthcare Practice at Western University in London, Ontario introduced a new, “Interprofessional Pain Management” (IPM) field. The program follows a competency-based framework, and the learners are all practicing healthcare providers with a special interest in pain. Part of the purpose of this thesis is to describe the process of development and implementation. The objective is to provide educators and healthcare providers an in-depth look at how the pain education is experienced. This includes exploring the lived experience …

The Psychosocial And Physical Effects Of Therapeutic Horseback Riding For Children With Cerebral Palsy, Karen M. Pratt

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Background: Participation in specialized adapted activities such as therapeutic horseback riding (THR) is critical for children with cerebral palsy (CP) as they are at increased risk for lower habitual physical activity levels, social exclusion and mental health conditions. The benefits of THR for children CP are unclear despite positive anecdotal evidence. Purpose: The aim of the study is to explore the effects of THR participation for children with CP across multiple domains of health (psychological, social and physical) from the children themselves. Specifically, this study explored overall wellbeing including mental health, perceived independence, social inclusion and presence of fatigue and …

Therapist Perception Of The Clarity And Implementability Of Relevant Recommendations From American Academy Of Orthopedic Surgeon’S Distal Radius Fracture Clinical Practice Guidelines, Saravanan Esakki

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Fractures of the distal radius are common and can cause substantial either transient or permanent impairment and disability.

Clinical practice guidelines (CPGs) are systematically developed statements or recommendations based on the best available evidence and aimed at assisting health care practitioners in clinical decision-making. Many professional organizations have developed practice guidelines for common clinical conditions. The overall objective of this thesis is to evaluate the therapist's perception of the clarity and implementability of rehabilitation relevant recommendations from The American Academy of Orthopaedic Surgeons (AAOS) CPG for distal radius fractures (DRF) and to identify the quality of CPG related to DRF. …

Assessment Of Landing Biomechanics And Rehabilitation After Anterior Cruciate Ligament Reconstruction, Sheila S. Gagnon

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Aberrant landing biomechanics increase the risk of anterior cruciate ligament (ACL) injury and are a focus of rehabilitation after ACL reconstruction. The purpose of the present thesis was to develop and evaluate methods of assessing landing mechanics and investigate the effects of different rehabilitation strategies after ACL reconstruction. Three studies were conducted. The first study used a Delphi process to develop the content of a Clinician-Rated Drop Vertical Jump Scale to evaluate jump landing mechanics during rehabilitation after ACL reconstruction. Twenty experts participated in four rounds of questioning, resulting in 92% agreement for knee valgus collapse, lateral trunk lean, insufficient …

Cardiovascular Effects Of Exercise And Use Of Abdominal Binder In Patients Of Parkinson’S Disease With Orthostatic Hypotension, Faizan Ahmed

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Orthostatic hypotension (OH) is a common manifestation of autonomic dysfunction in Parkinson’s Disease. It can adversely affect a patient’s functional capacity, exercise tolerance and quality of life, while increasing the risk of falls, cerebrovascular disease and overall mortality. Use of an abdominal binder (AB) can help counter OH; however, this has not been sufficiently studied in patients with Parkinson’s Disease (PwPD). Moreover, the hemodynamic effects of upper and lower extremity exercise are unclear in PwPD with OH. Although OH can impair the cerebral circulation, the consequences on the cerebral hemodynamics of wearing an AB or performing exercise are unknown in …

Joint Protection Programs For People With Hand Arthritis, Pavlos Bobos

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The fact that Joint Protection Programs (JPP) can reduce pain and improve function is based on small, but definitive Randomized Controlled Trials (RCTs), conducted in the 1980s. However, changes over time in the nature of hand use, the rapid expansion of technology, and improvements in our understanding of health literacy mean that these programs are now outdated. Further, problems with adherence to JPP are well documented. The purpose of this thesis was 1) to conduct a scoping review to map all the available evidence around joint protection programs in published and unpublished studies 2) to evaluate the effectiveness of joint …

Therapeutic Interventions For Managing Diabetic Shoulder, Sanaa A. Alsubheen

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Shoulder pain is a common complaint of diabetic patients that causes motion limitations and functional disability. Adhesive capsulitis (AC) is the most common disabling shoulder disorder. There is no optimal non-surgical treatment for managing AC in diabetic patients. Furthermore, the impact of diabetes on shoulder recovery and factors predicting shoulder function following shoulder arthroplasty is not well investigated.

Purpose and Methods

The main purpose of this thesis was to inform clinical practice about the best intervention for managing AC in diabetic patients, and to assess the impact of diabetes on functional outcomes after shoulder arthroplasty, with the following objectives: 1) …

The Symbiome Project: An Exploratory Investigation Of The Biological, Psychological, And Social Mechanisms That Contribute To The Transition From Acute To Chronic Musculoskeletal Pain, Joshua Y. Lee

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This dissertation presents the initial findings of the SYMBIOME project; which attempts to combine the objective and subjective aspects of musculoskeletal pain to develop a prognostic clinical phenotype. Chapter 2 presents a moderator analysis of functional outcomes (pain interference and pain severity). Psychosocial moderators can affect the relationship between biomarkers and pain. For pain severity, TNF-α, TGF-β1, and CRP were moderated by employment status, pre-existing psychopathology, and sex. For pain interference, IL-1β, cortisol, TGF-β1, CRP, and IL-6 were moderated by pre-existing pain, peri-traumatic fear, region of injury, and peri-traumatic stress. Chapter 3 presents a latent growth curve analysis in determining …

Assessment Of Intrinsic Hand Neuromuscular Physiology, Philemon Tsang

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Alterations to the peripheral nervous system and neuromuscular physiology may impact hand function in a typical or clinical population, such as individuals with ulnar neuropathy. The mechanisms that influence these positive and negative changes are still not well understood. The three studies within my thesis aim to validate the reliability of decomposition-based quantitative electromyography (DQEMG) measurements and explore the changes in intrinsic hand neuromuscular physiology in a typical aging population and individuals recovering from a surgical intervention for severe ulnar neuropathy.

The purpose of the first study was to determine the test-retest reliability of near-fibre (NF) jiggle, a measure of …

Recovery Following Proximal Humerus Fracture, Azar Varahrami Vigeh

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There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated …

The Nature And Consistency Of Exercise Reporting In Rehabilitation Following Rotator Cuff Repair, Dinesh Balachandran

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Abstract

Purpose:

Rotator cuff repair is conventional surgery, and postoperative rehabilitation programs are routine. Optimization and implementation of evidence-based exercise are dependent on comprehensive reporting of intervention content and dosage. The purpose of this study is to examine the content and consistency of reporting of postoperative exercise programs following arthroscopic rotator cuff repairs.

Methods:

Keyword search of PUBMED, EMBASE, Scopus, SPORTDiscuss, AMED, CINAHL, and Cochrane were performed from January 1950 to March 2019. All the studies that discussed rehabilitation following rotator cuff repairs of human adults were included. A Proforma Consensus on Exercise Reporting Template (CERT) assessment form was used …