Medicine and Health Sciences Commons^™

Problem Solving Of Typically Developing Children On An Adaptation Of The Twenty Questions Task, Janice Carter Smith

Theses and Dissertations--Rehabilitation Sciences

This cross sectional study examined problem solving by typically developing children on the Rapid Assessment of Problem Solving test (RAPS). The RAPS, a modification of Mosher and Hornsby’s 20Q task, requires the examinee to solve three problems. Each problem involves asking yes/no questions to identify a target picture from a 32-picture array with as few questions as possible. Participants were 73 young (ages 7-9), 79 early adolescent (ages 10-13) and 77 adolescent (ages 14-17) children residing in Kentucky. Children were seen in the summer months and administered the RAPS on a single occasion, with 22 of the children being testing …

Exploration Of Factors Associated With Patient Adherence In Upper Extremity Rehabilitation: A Mixed-Methods Embedded Design, Enrique V. Smith-Forbes

Theses and Dissertations--Rehabilitation Sciences

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem.

The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence.

The first purpose of this dissertation was to explore the MAM …

"Bent But Not Broken": A Mixed Methods Study Of Mothering During Chemotherapy For Breast Cancer, Julie A. Baltisberger

Theses and Dissertations--Rehabilitation Sciences

Breast cancer is the most common cancer diagnosis of women, with an estimated 232,670 new cases in 2014. With 89.2% of breast cancer patients surviving five years or longer, studies are needed to investigate the long-term impact of breast cancer on women and families (National Cancer Institute, 2014).

The purpose of this study was to examine, using a mixed methods approach, the impact of chemotherapy on mothering occupations for patients diagnosed with breast cancer. Thirty-one women (mean age=39.6, SD=5.79), with breast cancer of any stage, who were currently undergoing chemotherapy and had at least one child under the age of …

Perception And Use Of Communication Care Plans By Certified Nursing Assistants In Nursing Homes: The Role Of Professional Support, Christen G. Page

Theses and Dissertations--Rehabilitation Sciences

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs.

The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care …

Effects Of An Online Training In The Ziggurat Model On The Autism Knowledge Of School-Based Speech-Language Pathologists (Slps), Wendy L. Wilkerson

Theses and Dissertations--Rehabilitation Sciences

Autism Spectrum Disorder (ASD) is a low-incidence disorder with high impacts on individuals, families, and society. School-based speech-language pathologists (SLPs) have tremendous responsibilities toward individuals with ASD, but pre-service SLPs are not adequately trained to fulfill these expectations. In order to reduce the widespread financial and social impact of ASD, school-based SLPs need to complete effective training to prepare them for the selection of established social-communication practices. One framework for the selection of individualized intervention is the Ziggurat Model (Aspy & Grossman, 2008). The following study used mixed methods to investigate the research question: “Does the ASD knowledge base of …

Occupational Therapists' Experiences With Ethical And Occupation-Based Practice In Hospital Settings, Joanne P. Estes

Theses and Dissertations--Rehabilitation Sciences

Changes in health care delivery practices are impacting the provision of care in all venues. Occupational therapists working in hospital settings strive to meet professional mandates for occupation-based practice within a medical-model system. Ethical practice is another aspect of service provision vulnerable to contextual influences. The aims of the two studies reported here were to explore occupational therapists’ experiences with occupation-based practice, and with ethical issues, in hospital settings. Grounded theory methods were employed for both studies. Data were collected via individual, semi-structured interviews with 22 participants for the first study. For the second study, nine participants participated in individual, …

Play In Children With Motor Disabilities, Suzanne Martin

Theses and Dissertations--Rehabilitation Sciences

The purpose of this research was to explore and describe the relationship among the child, family, home environment, and pretend play of children with motor disabilities. The environment is a powerful force in early child development. This research is based on Bronfennbrenner’s ecological theory of development and the ubiquitous role of play in all domains of development. Children with motor disabilities may lack exploration of the environment and as a consequence demonstrate deficits in play. Play was measured in 32 children with motor disabilities aged 24.8 to 61.3 months with a mean age of 33.7 (SD 9.3) months. Children demonstrated …

The Relationship Between Patient Expectations, Functional Outcome, Self-Efficacy, And Rehabilitation Adherence Following Cartilage Repair Of The Knee: A Sequential Explanatory Analysis, Jenny L. Toonstra

Theses and Dissertations--Rehabilitation Sciences

Patient expectations have been shown to be a major predictor of outcomes. Furthermore, fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, pre-operative function, or disease characteristics. However, it is currently unknown what factors and to what degree they may influence patient expectations prior to knee surgery. Furthermore, understanding the importance and values of those expectations for recovery using qualitative methods has not previously been conducted in this patient population.

A mixed methods design was used. Twenty-one participants scheduled to undergo cartilage repair of the …

The Relationship Of Somatosensory Perception And Fine-Force Control In The Adult Human Orofacial System, Nicole M. Etter

Theses and Dissertations--Rehabilitation Sciences

The orofacial area stands apart from other body systems in that it possesses a unique performance anatomy whereby oral musculature inserts directly into the underlying cutaneous skin, allowing for the generation of complex three-dimensional deformations of the orofacial system. This anatomical substrate provides for the tight temporal synchrony between self-generated cutaneous somatosensation and oromotor control during functional behaviors in this region and provides the necessary feedback needed to learn and maintain skilled orofacial behaviors.

The Directions into Velocity of Articulators (DIVA) model highlights the importance of the bidirectional relationship between sensation and production in the orofacial region in children learning …

A Comparison Of Upper Extremity Function Between Female Breast Cancer Survivors And Healthy Controls: Typical Self- Report Of Function, Motion, Strength And Muscular Endurance, Mary Insana Fisher

Theses and Dissertations--Rehabilitation Sciences

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment.

The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. …

Alterations In Visual Processing And Its Impact On Upright Postural Stability In Athletes Following Sport-Related Concussion, Andrea E. Cripps

Theses and Dissertations--Rehabilitation Sciences

Athletes are at risk of sustaining a concussion in all sports and at all competitive levels which may lead to balance impairments. Balance results from the integration of visual, vestibular, and somatosensory information. The underlying pathophysiology for balance impairments is not well understood and visuo-motor processing impairments and how these impairments contribute to balance in concussed athletes has not been reported. Objectives: (1) to investigate the influence of visual perturbation on upright postural stability and balance in athletes who have recently suffered a sports-related concussion, (2) to establish the test-retest reliability of a simple visuo-motor processing task. Design: A longitudinal, …

Description And Service Innovation In Adolescent Transition Within Kentucky State Agency Education Programs, Amy C. Marshall

Theses and Dissertations--Rehabilitation Sciences

Of all Kentucky youth, state agency children are at the highest risk of making unsuccessful post-secondary transitions to adulthood. The intent of both studies comprising this dissertation was to understand and guide transition planning to make future improvements to transitions of adolescents in state agency programs.

The Kentucky Youth at Risk in Transition Study was a mixed methods study that identified and described the understandings of student transitions in state agency education programs from the perspectives of youth and administrators. The study included 105 nontraditional education programs funded and supervised by the Kentucky Educational Collaborative for State Agency Children (KECSAC). …

Predictors Of Outcome Following Standardized Rehabilitation For Patients With Shoulder Pain, Stephanie D. Moore

Theses and Dissertations--Rehabilitation Sciences

Shoulder dysfunction is frequently treated and persistent symptoms are common. Differential diagnosis of shoulder injuries can be challenging and knowledge of a diagnosis alone does not appear to be enough information to predict outcomes. Determination of a set of factors that predict outcome would assist clinicians in making the most effective treatment decision for patients with shoulder pain. The purposes of this dissertation were to investigate patient-clinician agreement in an orthopedic population of patients with shoulder pain and to determine what combination of factors best predicts positive patient-reported outcome following standardized rehabilitation in patients with shoulder pain.

In the first …

Developing The Rehabilitation Education For Caregivers And Patients (Recap) Model: Application To Physical Therapy In Stroke Rehabilitation, Megan M. Danzl

Theses and Dissertations--Rehabilitation Sciences

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.

Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. …

Anterior Cruciate Ligament Prevention: Effect Of Neuromuscular Training Compliance On Muscular Strength Development, Daisuke Sugimoto

Theses and Dissertations--Rehabilitation Sciences

The anterior cruciate ligament (ACL) originates from posterior part of the medial side of the lateral condyle of femur to anterior intercondylar notch between a transverse meniscal ligament and medial side of medial meniscus of tibia. Once ACL is disrupted, pain, effusion and atrophy are commonly observable and cause functional disability. Because of the functional limitations, athletic participation is severely restricted. ACL injury is more prevalent in physically active females compared to their male counterparts in the sports of basketball and soccer in high school and collegiate levels.

Several attributes of females are considered risk factors for the higher ACL …

Scapular Muscle Assessment In Patients With Lateral Epicondylalgia, Joseph M. Day

Theses and Dissertations--Rehabilitation Sciences

The role rehabilitation plays in the management of patients with lateral epicondylalgia (LE) remains elusive secondary to high recurrence rates. Addressing scapular muscle deficits may be important in the rehabilitation of patients with LE. However, it is unknown if scapular muscle impairments exist in a working population of patients with LE. The purpose of this dissertation was to assess scapular muscle strength and endurance in a working population of patients with LE.

Clinical scapular muscle assessment tools are limited in their ability to isolate specific muscles. Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool but few studies have investigated …

Immunomodulatory Effects Of Massage In Skeletal Muscle, Christine Waters Banker

Theses and Dissertations--Rehabilitation Sciences

The inflammatory process is a critical component of the repair and regeneration of skeletal muscle following injury. The influx of innate immune cells following injury is intricate, and temporal nature. Although required for proper repair and regeneration, the inflammatory process has been shown to exacerbate initial damage, prolonging the healing process. Complementary Alternative Medicine (CAM) treatments, such as massage therapy, are a promising substitute for pharmaceutical modulation of the inflammatory response, and recent studies into the efficacy of massage have begun to report the physiological benefits of massage application following injury. Nonetheless, there is a significant lack of sound mechanistic …

Effects Of Proximal Stability Training On Sport Performance And Proximal Stability Measures, Thomas Gerard Palmer

Theses and Dissertations--Rehabilitation Sciences

Proximal stability, or the ability to stabilize and actively control the spine, pelvis and trunk, has been reported to influence sport performance. Traditional training practices for the proximal segments have had little success improving sport performance. The purpose of this dissertation was to investigate the effects a sport specific proximal stability training program can have on throwing velocity and measures of muscular endurance and power which target the proximal segments of the pelvis, spine and trunk.

A stratified randomized clinical trial was implemented with a pre- to post-intervention design. Forty-six healthy, Division III collegiate female softball (n=17) and male baseball …

Serum Cartilage Oligomeric Matrix Protein: A Biomarker For Acute Articular Cartilage Damage, Johanna M. Hoch

Theses and Dissertations--Rehabilitation Sciences

Bone bruise lesions (BBL) are documented on MRIs diagnosing acute knee ligament injury (AKLI). Recent evidence has indicated that a majority of patients that sustain an AKLI, especially anterior cruciate ligament (ACL) knee injury, will develop post-traumatic osteoarthritis (PTOA) 10-20 years following injury. It has been proposed that the initial damage sustained to the articular cartilage overlying BBL causes a cascade of events that may result in PTOA.

Researchers have proposed a modification to treatment protocols for more severe BBL, or have stressed the need for the development of protective therapies to protect the articular cartilage. However, there are limited …

A Comparison Of Group Versus Individual Therapy On The Output Of Appropriate Utterances In A Six-Year-Old Girl With Autism: A Case Study, Mckinzie Craig Sheridan

Theses and Dissertations--Rehabilitation Sciences

Children with autism spectrum disorders typically experience language deficits in multiple areas, including form, content, and use. These children often receive speech therapy with individual sessions (one child and clinician), group sessions (several children), or a combination of both. Although research has deemed individual therapy successful, there is still debate regarding the success of group therapy, and there is virtually no literature examining a comparison between individual and group therapy. The current case-study investigated the relative effectiveness of individual versus group therapy for one six-year-old female with moderate autism spectrum disorder. The child underwent ten alternating therapy sessions of similar …

Developing A Model Of Client Satisfaction With A Rehabilitation Continuum Of Care, Melba G. Custer

Theses and Dissertations--Rehabilitation Sciences

Client satisfaction is an important outcome indicator because it measures multiple domains of the quality of healthcare and rehabilitation service delivery. It is especially important in occupational therapy because it is also client-centered. There are multiple domains of satisfaction and findings described in previous research; however, there is no single standard of measuring client satisfaction or any single working model describing the relationship among variables influencing satisfaction. This research was designed to apply a measure of satisfaction in rehabilitation and to develop a working model of satisfaction.

This study was an exploratory and predictive study using a large existing dataset …

Rural Speech-Language Pathologists' Perceptions And Knowledge Of Emergent Literacy Instructional Practices: A Mixed Methods Study, Kellie C. Ellis

Theses and Dissertations--Rehabilitation Sciences

The acquisition of emergent literacy skills has become a prominent focus of early childhood education programs in recent years as research has demonstrated the significance of emergent literacy ability in the process of learning to read. The effectiveness of use of varied instructional techniques targeting the emergent literacy domains of phonological awareness, written language awareness, emergent writing, and oral language is well described in the literature. Consequently, educational service providers like speech-language pathologists are being called upon to assume roles in emergent literacy service provision. However, research has not fully explored the perceptions and knowledge speech-language pathologists possess of emergent …

The Use Of Explicit, Non-Evocative Print Referencing With Preschool Children At-Risk: Implications For Increasing Print Concept Knowledge, Susan Thomas Frank

Theses and Dissertations--Rehabilitation Sciences

The purpose of this research study was to investigate the learning of print concepts (PCs) by preschool children at risk for literacy problems using an experimental treatment: explicit, non-evocative print referencing. Children from low socio-economic status (SES) families have been determined to be at-risk for literacy learning problems including a reduced knowledge of print concepts.

The study incorporated a multiple group (experimental and control) time series design with persistent insertion of treatment to those subjects who were assigned to the experimental condition. Participants included 25 children at-risk, ages 4:0- 4:11 (years: months) who qualified for pre-school services and for subsidized …

Environmental Influences On Occupational Therapy Practice, Camille L. Skubik-Peplaski

Theses and Dissertations--Rehabilitation Sciences

Rehabilitation hospitals serve to foster a client’s independence in preparation to return home after an injury or insult. Having space in rehabilitation environments that is home-like and supportive for each client can facilitate participation in occupations and assist in learning and practicing the skills needed to transition to home. Yet, typically occupational therapists provide interventions to clients in therapy gyms with exercise and impairment based equipment. Currently the stroke population is changing and identifying the optimal rehabilitation environment is imperative to guide occupational therapy practice. This dissertation contains three studies relating to the rehabilitation environment and occupational therapy interventions. The …

Age, Attention, And Ots In A Constrained Vs Unconstrained Task, Courtney Leann Jensen

Theses and Dissertations--Rehabilitation Sciences

The discourse of older healthy adults is commonly described as lengthy and off-topic and thought to be associated with a general cognitive decline that occurs in healthy aging. This study investigated the overall decline in attention associated with healthy aging and its relationship to instances of off-topic speech (OTS) in a constrained and unconstrained language production task. Ninety cognitively healthy adults participated and comprised three age cohorts (40 – 75+). Participants completed cognitive measures of attention and two discourse tasks that included recounting personal events and describing a procedure. Older adults exhibited poorer scores on measures of selective and shifting …

The Development Of The Self-Efficacy Of Balance Scale (Sebs): Investigation Of Psychometric Properties In Female Basketball Players, Carrie Silkman Baker

Theses and Dissertations--Rehabilitation Sciences

Lower extremity injuries are the most common sports related injury. Many steps have been taken to attempt to identify individuals who might be at a higher risk for sustaining a lower extremity injury. Resource and time intensive screening techniques have been used previously to attempt to identify such individuals. However these techniques have focused heavily on postural control and landing mechanics in athletes, no psychological measure has been used to identify individuals who might be at a higher risk of lower extremity injury.

Self-efficacy of balance can be defined as how capable an individual feels he or she can balance …

Use Of A Video Game Based Balance Training Intervention On The Balance And Function Of Children With Developmental Disabilities, Gina C. Siconolfi-Morris

Theses and Dissertations--Rehabilitation Sciences

Many children with developmental disabilities (DD) have physical impairments and limitations in their participation. Rehabilitation research often focuses on either physical impairments or participation restrictions, when both need to be investigated. The purposes of these two studies were to evaluate an at home therapist directed video game balance training intervention on balance, gait velocity (GV), hip strength and activities of children with DD. The pilot study was a single-subject non-concurrent multiple baseline design. Balance measures included: weight bearing symmetry; center of pressure area and velocity; time to boundary mean minima and standard deviation; and timed up and go. The participant’s …

Effects Of Response Elaboration Training On Sentence Production Of Persons With Chronic Agrammatic Aphasia, Ryan S. Husak

Theses and Dissertations--Rehabilitation Sciences

Purpose: Response Elaboration Training (RET) is a treatment program for increasing the amount of information contained in the speech of individuals with aphasia. This study employed a sentence production task (SPT) to examine whether RET will (1) generalize to a task not worked on in treatment and (2) affect syntactic performance.

Methods and Procedures: Three adults with chronic non-fluent Broca’s aphasia received RET in this prospective, repeated case study. The dependent variable was a SPT requiring the participant to put a verb in a sentence. Changes in the syntactic performance of the participant’s sentence productions were classified across …

Clinical And Functional Assessment Following Autologous Chondrocyte Implantation To The Knee: The Role Of Patient Reported Outcomes, Performance Based Assessment, And Response Shift, Jennifer Sebert Howard

Theses and Dissertations--Rehabilitation Sciences

Autologous chondrocyte implantation (ACI) is a cell based therapy for the treatment of articular cartilage defects. Numerous studies have reported outcomes following ACI using a variety of patient reported outcomes (PROs), but no clear recommendations exist regarding which PRO is the most responsive to changes following ACI. Few studies have documented changes in performance based assessments (PBAs) following ACI. Response shift theory proposes that residual changes in self-report measures occur over time. Failing to account for response shift may result in over or under reporting of outcomes from which clinical decisions are made. The purposes of this dissertation were 1) …