Rehabilitation and Therapy Commons^™

Cortical Activation During Shoulder And Finger Movements In Healthy Adults: A Functional Near-Infrared Spectroscopy (Fnirs) Study., Chieh-Ling Yang, Shannon B Lim, Sue Peters, Janice J Eng

Physical Therapy Publications

Characterization of cortical activation patterns during movement of the upper extremity in healthy adults is helpful in understanding recovery mechanisms following neurological disorders. This study explores cortical activation patterns associated with movements of the shoulder and fingers in healthy adults using functional near-infrared spectroscopy (fNIRS). Twelve healthy right-handed participants were recruited. Two motor tasks (shoulder abduction and finger extension) with two different trial lengths (10 s and 20 s) were performed in a sitting position at a rate of 0.5 Hz. The hemodynamic response, as indicated by oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR), over both hemispheres was acquired using a 54-channel …

The Occupational Therapy Examination And Practice Preparation (Otepp) Program: Development, Implementation And Evaluation Of An Educational Program For Internationally-Educated Occupational Therapists, Colleen E. Mcgrath

Occupational Therapy Publications

This paper provides a chronological overview of the development, implementation, and evaluation of an educational initiative aimed at ensuring internationally-educated occupational therapists are prepared to enter practice in their new country, Canada. The three major phases of the program’s 12-year evolution are described, to distill the key lessons learned at each phase. Data related to the demographics of participants, program content, results of the national examination, registration, and employment outcomes are included. An enhanced understanding of the transition experience of internationally educated occupational therapists provides a strong foundation from which to support internationally-educated colleagues and strengthen the occupational therapy profession.

Centering The Complexity Of Long-Term Unemployment: Lessons Learned From A Critical Occupational Science Inquiry, Rebecca Aldrich, Debbie Rudman, Na Eon(Esther) Park, Suzanne Huot

Occupational Therapy Publications

Inquiries that rely on temporal framings to demarcate long-term unemployment risk generating partial understandings and grounding unrealistic policy solutions. In contrast, this four-phase two-context study aimed to generate complex understandings of post-recession long-term unemployment in North America. Grounded in a critical occupational perspective, this collaborative ethnographic study also drew on street-level bureaucracy and governmentality perspectives to understand how social policies and discursive constructions shaped people’s everyday ‘doing’ within the arena of long-term unemployment. Across three phases, study methods included interviews with 15 organizational stakeholders who oversaw employment support services; interviews, participant observations, and focus groups with 18 people who provided …

Occupational Therapists As Street-Level Bureaucrats: Leveraging The Political Nature Of Everyday Practice., Rebecca M Aldrich, Debbie Rudman

Occupational Therapy Publications

BACKGROUND.: As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as "street-level bureaucrats" ( Lipsky, 1980/2010 ) who effect and are affected by policy.

PURPOSE.: Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being.

KEY ISSUES.: By highlighting practitioners' everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the …

Supports For Migrant Farmworkers: Tensions In (In)Access And (In)Action, Susana Caxaj, Amy Cohen, Sarah Marsden

Health and Rehabilitation Sciences Publications

Purpose: This study examined the role of support actors in promoting or hindering access to migrant agricultural workers' (MAWs) needs, and, to determine the factors that influence adequate support for this population.
Methodology: Employing a Situational Analysis methodology, we carried out focus groups and interviews with 35 support actors complimented by a community scan (n=28) with public-facing support persons and a community consultation with migrant agricultural workers (MAWs).
Findings: Two major themes were revealed: (In)access and (In)action, and; Blurred Lines in Service Provision. The first illustrated how support actors could both reinforce or challenge barriers for this population through tensions …

Functional Electrical Stimulation Plus Visual Feedback Balance Training For Standing Balance Performance Among Individuals With Incomplete Spinal Cord Injury: A Case Series, David J Houston, Jae W Lee, Janelle Unger, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during walking or standing. Our objective was to evaluate a therapeutic tool for standing balance that combined functional electrical stimulation, applied bilaterally to the plantarflexors and dorsiflexors, with visual feedback balance training (FES+VFBT). Five adults with iSCI completed 12 FES+VFBT sessions over 4 weeks. During the training sessions, participants completed each of the four balance exercises twice. Visual feedback of the center-of-pressure (COP) location was provided as participants completed the balance exercises and received FES to assist with performance of the exercises. A closed-loop FES system was …

Comparison Of Functional And Patient-Reported Outcomes Between Direct Anterior And Lateral Surgical Approach One-Year After Total Hip Arthroplasty In A Canadian Population: A Cross-Sectional Study., Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward Vasarhelyi, Brent Lanting

Physical Therapy Publications

Background: From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery.

Methods: We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, …

A Participatory Filmmaking Process With Children With Disabilities In Rural India: Working Towards Inclusive Research, Colleen E. Mcgrath

Occupational Therapy Publications

Children with disabilities often experience exclusion within their communities, and this exclusion can extend into research processes. The United Nations Convention on the Rights of the Child, however, emphasizes that children of all abilities need to be involved as decision makers in matters affecting them. This article provides an in-depth description of the process of a participatory action research project carried out with children with disabilities from a rural village in India. It argues for the utility of participatory filmmaking as a research methodology that supports inclusion of children with disabilities as co-researchers in research and action processes. The …

Using Participant Observation To Enable Critical Understandings Of Disability In Later Life: An Illustration Conducted With Older Adults With Low Vision, Colleen E. Mcgrath

Occupational Therapy Publications

Research with older adults aging with vision loss has typically been informed by a biomedical theoretical framework. With a growing focus, however, on critical disability perspectives, which locates disability within the environment, new methods of data collection, such as participant observation, are needed. This article, which reports on the findings from a critical ethnographic study conducted with older adults with age-related vision loss (ARVL), aims to share those insights gained through participant observation and to demonstrate the utility of this method. Three insights were gained including the adaptive strategies tacitly employed to navigate the physical environment, a grounded understanding of …

Longitudinal Change In Common Impairments In Children With Cerebral Palsy From Age 1.5 To 11 Years, Lynn M Jeffries, Alyssa Laforme Fiss, Sarah Westcott Mccoy, Lisa Avery

Physical Therapy Publications

Purpose: This project aimed to determine if change occurs over time for impairments of balance, range of motion (ROM), endurance, and strength of children with cerebral palsy (CP), by Gross Motor Function Classification System (GMFCS) levels.

Methods: Measurements were completed in 77 children at two sessions (T1, T2) on average 5.8 years apart. Mean ages were 2.9 years (SD .9) and 8.7 years (SD 1.1) at T1 and T2, respectively.

Results: Significant differences were noted from T1 to T2 for some children (GMFCS levels I, II, and III/IV: balance increased, GMFCS levels I and II: strength increased, and GMFCS levels …

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Brain Activity Associated With Dual-Task Performance Of Ankle Motor Control During Cognitive Challenge., Sue Peters, Janice J Eng, Teresa Liu-Ambrose, Michael R Borich, Elizabeth Dao, Ameen Amanian, Lara A Boyd

Physical Therapy Publications

INTRODUCTION: Skilled Ankle motor control is frequently required while performing secondary cognitively demanding tasks such as socializing and avoiding obstacles while walking, termed "Dual tasking." It is likely that Dual-task performance increases demand on the brain, as both motor and cognitive systems require neural resources. The purpose of this study was to use functional MRI to understand which brain regions are involved in resolving Dual-task interference created by requiring high levels of Ankle motor control during a cognitive task.

METHODS: Using functional MRI, brain activity was measured in sixteen young adults during performance of visually cued Ankle plantar flexion to …

Physical, Occupational, And Speech Therapy For Children With Cerebral Palsy., Sarah Westcott Mccoy, Robert Palisano, Lisa Avery, Lynn Jeffries, Alyssa Laforme Fiss, Lisa Chiarello, Steve Hanna

Physical Therapy Publications

AIM: To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).

METHOD: We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal …

Self-Care Trajectories And Reference Percentiles For Children With Cerebral Palsy., Robert J Palisano, Lisa A Chiarello, Lisa Avery, Steven Hanna, On Track Study Team

Physical Therapy Publications

Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP).

Methods: Participants were 708 children with CP, 18 months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents' completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles. …

Longitudinal Changes In Physical Caregiving For Parents Of Children With Cerebral Palsy., Mohammed S Alghamdi, Lisa A Chiarello, Robert J Palisano, Sarah W Mccoy, Margo Orlin, Ehab M Abd-Elkafy

Physical Therapy Publications

Aims: To determine changes in physical caregiving for parents of children with cerebral palsy (CP) over a two-year period based on children’s gross motor function level and age.

Methods: 153 parents of children with CP rated their physical caregiving using the Ease of Caregiving for Children three times over two years. Parents and assessors classified children’s gross motor function using the Gross Motor Function Classification System (GMFCS). Physical caregiving was compared at three test times among parents of children grouped by GMFCS level (I, II–III, and IV–V) and age (1.7–5.9 and 6–11 years) using a three-way mixed ANOVA.

Results: Among …

Modulation Of The Hoffmann Reflex In The Tibialis Anterior With A Change In Posture., Janelle Unger, Justin W Andrushko, Alison R Oates, Doug W Renshaw, Trevor S Barss, E Paul Zehr, Jonathan P Farthing

Physical Therapy Publications

Hoffmann (H-) reflex amplitudes in plantar flexor soleus muscle are modulated by posture, yet dorsiflexor tibialis anterior (TA) H-reflex parameters have sparingly been studied. The purpose was to investigate modulation of the TA H-reflex when postural demands are increased from sitting to standing. In this study, data from 18 participants (Age: 25 ± 4 years, Height: 170.9 ± 9.5 cm, Weight: 75.9 ± 17.2 kg) allowed comparison of two experimental conditions involving different postures (i.e. sitting and standing). Maximal amplitude of the TA H-reflex (H_max) as a percent of the maximal M-wave amplitude (M_max) …

Dance As A Protective Measure Against The Cognitive And Physical Declines Associated With Aging: A Proposed Study, Sarah M. Schwanz, Jeffrey Holmes, Jessica Grahn

Western Research Forum

Background:

Dance is considered a multimodal activity in that it requires both physical and cognitive engagement. Combining physical activity with music may have a synergistic effect, enabling dance to enhance physical and cognitive functions more than music and physical activity alone. The positive changes attributed to dance training such as improved visuospatial and motor ability, high coordination, greater balance, and increased cognitive ability may also benefit individuals as they age.

Methods:

This proposed study will examine whether dance training has the potential to protect against age-related cognitive and physical decline by assessing the cognitive and physical domains that show decline …

Interpreting Patient Reported Outcomes In Orthopaedic Surgery: A Systematic Review, Shgufta Docter, Zina Fathalla, Michael Lukacs, Michaela Khan, Morgan Jennings, Shu-Hsuan Liu, Dong Zi, Dianne Bryant

Western Research Forum

Background: Reporting methods of patient reported outcome measures (PROMs) vary in orthopaedic surgery literature. While most studies report statistical significance, the interpretation of results would be improved if authors reported confidence intervals (CIs), the minimally clinically important difference (MCID), and number needed to treat (NNT).

Objective: To assess the quality and interpretability of reporting the results of PROMs. To evaluate reporting, we will assess the proportion of studies that reported (1) 95% CIs, (2) MCID, and (3) NNT. To evaluate interpretation, we will assess the proportion of studies that discussed results using the MCID or the effect sizes and how …

Does Improved Physical Function Following A Nustep® Seated All Extremity Exercise Intervention Reduce The Fear Of Falling And Improve Quality Of Life In Older Adults With Fear Of Falling Living In Community Care Homes?, Navjot Gill, Denise Connelly

Western Research Forum

Background:

Decreased physical activity associated with fear of falling invokes a dangerous cycle of more fear, reduced activity and falls. NuStep is a seated all-extremity recumbent cross trainer which provides safe and efficient exercise training.

Hypotheses/Objectives:

The objectives of this study are to:

i. improve physical function and mobility of older adults living with a fear of falling with a NuStep;

ii. assess change in self-reported fear of falling and quality of life before and after the exercise intervention; and

iii. determine whether there is a relationship between exercise-related improved physical function/mobility with change in fear of falling and/or quality …

Psychometric Properties Of Standardized Balance Confidence, Fear Of Falling, And Falls-Efficacy Measures In People With Lower Limb Amputations, Jack Y. Wang, Susan W. Hunter, Ricardo Viana, Jeffrey D. Holmes, Michael Payne

Western Research Forum

Background:

In Canada, >50% of community-dwelling lower limb amputees (LLA) fall at least once each year, a rate that is almost twice that of community-dwelling older adults. While the physical consequences of falls may be readily apparent, psychological sequelae that follow may be just as, if not more, detrimental than an actual fall itself. Current measures of balance confidence show no change in LLA following discharge from rehabilitation. The limited detectable change may be due to content validity challenges of the measures as they were not developed for the unique challenges faced by LLA.

Objectives:

1) Review items from standardized …

Depression Affects Recovery Following Distal Radius Fracture: A Latent Class Analysis, Shirin Modarresi, David M. Walton, Joy C. Macdermid

Western Research Forum

Background: Most people recover within six months following distal radius fractures (DRFs) but some experience pain and disability for one year or longer. Therefore, it is important to understand the factors that can help predict recovery. According to the biopsychosocial model of pain, psychological aspects of a condition can play important roles in explaining recovery.

Objectives: To identify the recovery trajectories of patients with DRFs and to determine the degree to which depression affects these trajectories.

Methods: Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected …

The Experiences Of Physical Rehabilitation In Individuals With Spinal Cord Injuries: A Qualitative Thematic Synthesis., Janelle Unger, Hardeep Singh, Avril Mansfield, Sander L Hitzig, Erica Lenton, Kristin E Musselman

Physical Therapy Publications

PURPOSE: The purpose of this thematic synthesis review was to identify and synthesise published qualitative research on the perspectives of individuals with spinal cord injuries with respect to physical rehabilitation interventions.

MATERIALS AND METHODS: The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies.

RESULTS: In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean ± standard …

Ease Of Caregiving For Children: Re-Validation Of Psychometric Properties Of The Measure For Children With Cerebral Palsy Up To 11 Years Of Age., Mohammed S Alghamdi, Lisa A Chiarello, Lisa Avery, Robert J Palisano

Physical Therapy Publications

PURPOSE: To re-validate stability and hierarchal ordering of items, test-retest reliability, and construct validity of the Ease of Caregiving for Children measure for parents of children with cerebral palsy (CP) up to 11 years of age.

METHODS: Participants were 613 parents of children with CP between 1.5 and 11 years of age. Parents completed Ease of Caregiving for Children and both parents and therapists classified children's levels of gross motor, manual and communication functions.

RESULTS: Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty. Test-retest reliability was good: ICC = 0.69 (95% …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part I - Cane, Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: People with Alzheimer's disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD.

OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking.

METHODS: Seventeen participants with AD (age …

A Protocol Paper On The Preservation Of Identity: Understanding The Technology Adoption Patterns Of Older Adults With Age-Related Vision Loss (Arvl), Colleen E. Mcgrath

Occupational Therapy Publications

There are a growing number of older adults with age-related vision loss (ARVL) for whom technology holds promise in supporting their engagement in daily activities. Despite the growing presence of technologies intended to support older adults with ARVL, there remains high rates of abandonment. This phenomenon of technology abandonment may be partly explained by the concept of self-image, meaning that older adults with ARVL avoid the use of particular technologies due to an underlying fear that use of such technologies may mark them as objects of pity, ridicule, and/or stigmatization. In response to this, the proposed study aims to understand …

Validity Of The Early Activity Scale For Endurance And The 6-Minute Walk Test For Children With Cerebral Palsy., Alyssa Laforme Fiss, Lynn Jeffries, Allison Yocum, Sarah Westcott Mccoy, On Track Study Team

Physical Therapy Publications

PURPOSE: This study aimed to describe Early Activity Scale for Endurance (EASE) scores and 6-minute walk test (6MWT) distances of children with cerebral palsy (CP) by functional ability level, sex, and age and to examine the convergent validity of the 2 tests.

METHODS: A total of 708 participants with CP, Gross Motor Function Classification System (GMFCS) levels I to V, completed the EASE, and 376 of the study participants (3-12years), GMFCS levels I to III, completed the 6MWT.

RESULTS: Children with CP vary in EASE scores and 6MWT distances based on GMFCS level and, to a lesser extent, age. The …

Longitudinal Trajectories And Reference Centiles For The Impact Of Health Conditions On Daily Activities Of Children With Cerebral Palsy., Doreen J Bartlett, Jan Willem Gorter, Lynn M Jeffries, Lisa Avery, Steven E Hanna, On Track Study Team

Physical Therapy Publications

AIM: First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels.

METHOD: A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS …

Risk Factors For Falls In Individuals With Lower Extremity Amputations During The Pre-Prosthetic Phase: A Retrospective Cohort Study, Kimberly Vu, Michael W C Payne, Susan W. Hunter, Ricardo Viana

Physical Therapy Publications

BACKGROUND: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs.

OBJECTIVE: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase.

DESIGN: Retrospective chart audit.

SETTING: Inpatient rehabilitation program.

PARTICIPANTS: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASUREMENTS: The number of self-reported falls was recorded from the time …

Intensive Balance Training For Adults With Incomplete Spinal Cord Injuries: Protocol For An Assessor-Blinded Randomized Clinical Trial., Janelle Unger, Katherine Chan, Carol Y Scovil, B Catharine Craven, Avril Mansfield, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke.

OBJECTIVE: The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI).

DESIGN: The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration …

Obstacle Negotiation And Dual-Tasking In People With A Unilateral Transtibial Amputation., Humberto Omana, Michael Payne, Ricardo Viana, Susan Winnifred Hunter

Western Research Forum

Background: Falls in people with a lower limb amputation (PLLAs) are common and most often occur while walking, resulting in physical and psychological consequences that adversely affect quality of life. Walking is a complex motor task requiring cognitive resources. Due to walking with a prosthesis, PLLAs report focussing on every step they take, indicating greater cognitive needs. However, cognitive resources are limited, and most of our everyday activities also involve the simultaneous performance of motor and cognitive tasks, known as dual-tasking. The inter-relationship between mobility, cognition and postural stability in PLLAs using a prosthesis is just starting to be understood. …