Objective: To investigate the contributions of physiotherapy and occupational therapy to self-man... more Objective: To investigate the contributions of physiotherapy and occupational therapy to self-management interventions and the theoretical models used to support these interventions in chronic disease. Data sources: We conducted two literature searches to identify studies that evaluated self-management interventions involving physiotherapists and occupational therapists in MEDLINE, the Cochrane Library, CINAHL, EMBASE, AMED (Allied and Complementary Medicine), SPORTdiscus, and REHABDATA databases. Study selection: Four investigator pairs screened article title and abstract, then full text with inclusion criteria. Selected articles (n = 57) included adults who received a chronic disease self-management intervention, developed or delivered by a physiotherapist and/or an occupational therapist compared with a control group. Data extraction: Four pairs of investigators performed independent reviews of each article and data extraction included: (a) participant characteristics, (b) the self-management intervention, (c) the comparison intervention, (d) outcome measures, construct measured and results. Data synthesis: A total of 47 articles reported the involvement of physiotherapy in self-management compared with 10 occupational therapy articles. The type of chronic condition produced different yields: arthritis n = 21 articles; chronic obstructive pulmonary disease and chronic pain n = 9 articles each. The theoretical frameworks most frequently cited were social cognitive theory and self-efficacy theory. Physical activity was the predominant focus of the self-management interventions. Physiotherapy programmes included disease-specific education, fatigue, posture, and pain management, while occupational therapists concentrated on joint protection, fatigue, and stress management. Conclusions: Physiotherapists and occupational therapists make moderate contributions to selfmanagement interventions. Most of these interventions are disease-specific and are most frequently based on the principles of behaviour change theories.
Neurorehabilitation and neural repair, Jan 12, 2014
Although task-related walking training has been recommended after stroke, the theoretical basis, ... more Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke. To compare the impact of a motor-learning-science-based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset. In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. Th...
The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guid... more The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence.
A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) ... more A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) is the learning and relearning of motor skills. Therapists can apply theoretically derived and evidence-based motor learning strategies (MLSs) to structure the presentation of a task and organize the environment in ways that may promote effective, transfer-oriented practice. However, little is known about how MLSs are used in physical therapy interventions for children with ABI. The purpose of this study was to develop and validate an observer-rated Motor Learning Strategy Rating Instrument (MLSRI) quantifying the application of MLSs in physical therapy interventions for children with ABI. A multi-stage, iterative, item generation and reduction approach was used. An initial list of MLS items was generated through literature review. Seven experts participated in face validation to confirm item comprehensiveness. In a content validation process, 12 physical therapists with pediatric ABI experience responded to a questionnaire evaluating feasibility and importance of items. Six physical therapy sessions with clients with ABI were videotaped at a children's rehabilitation center. The 12 physical therapists participated in a session where they: (1) rated session videos to test the MLSRI and (2) provided verbal feedback. Revisions were made sequentially to the MLSRI based on these processes. The MLSRI was scored during videotape observation rather than being given a live rating, which may be onerous in certain settings and may influence therapist or child behavior. Further reliability investigations will determine whether the 33-item MLSRI is of help in documenting strategy use during intervention, as an evaluation tool in research, and as a knowledge transfer resource in clinical practice.
To identify and describe the application of 3 motor learning strategies (verbal instructions, pra... more To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.
Following earlier work by Mechsner et al. (Nature 414 (2001) 69), the purpose of this experiment ... more Following earlier work by Mechsner et al. (Nature 414 (2001) 69), the purpose of this experiment was to determine the perceptual and motoric contributions to bimanual coordination. Twenty right-handed, healthy, young adults performed continuous, horizontal, linear movements of both upper limbs at frequencies of 1.5 and 2.0 Hz. The goal was to control the spatial-temporal displacement of two flags by coordinating upper limb movements in two perceptual conditions. In a congruent condition, the movement of the flags matched the movement of the upper limbs. In an incongruent condition, the movement of the flags was opposite to the movement of the upper limbs. Measures of error in coordination provided support primarily for a motor view of bimanual coordination, and failed to replicate the earlier findings of Mechsner et al. q 2004 Published by Elsevier Ireland Ltd.
A temporary and/or involuntary stoppage of movement is identifiable in the execution phase of wri... more A temporary and/or involuntary stoppage of movement is identifiable in the execution phase of writing, walking, and turning movements in individuals with Parkinson's disease (PD) and may be referred to as freezing. However, the unpredictability of such akinetic impairments has made it difficult to study experimentally. The present study compared PD and age-matched control groups in their ability to coordinate continuous and simultaneous upper limb movements in trials involving two parts. In the first part of each trial, participants performed either in-phase movements (symmetric, simultaneous movement toward and away from the midline of the body), or anti-phase movements (isodirectional). At the midpoint of the trial, they were signaled by an auditory metronome to execute an intentional and voluntarily switch from the coordination currently being performed to the opposite coordination pattern. In the second half of the trial participants were required to maintain performance in the other coordination mode. All trials were paced by an auditory metronome at one of three different speeds (0.75, 1.25, 1.75 Hz). Measures of temporal coordination (relative phase) indicated that overall, participants with PD required significantly longer periods of time to achieve a switch between coordination patterns compared to healthy controls, and experienced greater difficulty changing from the in-phase to anti-phase mode of coordination. As well, movement stoppage was observed in 53.9% of the in-phase to anti-phase switch trials, but in only 15.5% of the anti-phase to in-phase trials. We conclude that interruptions to movement execution are most common when switching to coordinated movements that impose greater motor demands in individuals with PD.
Continuous coordinated movement of the upper limbs performed at different movement frequencies, a... more Continuous coordinated movement of the upper limbs performed at different movement frequencies, and with different external timing conditions, was examined in individuals with Parkinson's disease (PD) and healthy, age-and gendermatched controls. Participants performed symmetric in-phase movements toward and away from the midline of the body, and isodirectional anti-phase movements at one of three metronome speeds (0.75, 1.25, and 1.75 Hz), and in two different auditory cueing conditions (cue present, cue absent). Measures of relative phase accuracy (absolute mean error) and stability (standard deviation) revealed that individuals with PD performed in-phase movements as well as the controls, while anti-phase movements were performed with greater mean error and vari-ability. The adverse effects of PD on the anti-phase task were also reflected by freezing (8.1% of anti-phase trials) and hypometric deficits (5.1% of anti-phase trials) during movement. None of these PD-related impairments occurred during inphase trials. The overall accuracy or stability of movement coordination was not improved with the presence of external pacing cues, suggesting that although execution impairments of individuals with PD may be dramatically influenced by attention, external cueing does not necessarily improve movement performance.
Abstract The purpose of this paper is to describe the opportunities and challenges in the develop... more Abstract The purpose of this paper is to describe the opportunities and challenges in the development of a research group established to investigate and disseminate knowledge related to aging, mobility and participation. Various aspects of the research group are ...
To determine the relationship between the amount of intra-individual variability in measures of a... more To determine the relationship between the amount of intra-individual variability in measures of abilities and participation throughout the first 8 months of recovery from ABI and outcome scores at 1 year. Greater amounts of intra-individual variability throughout recovery are hypothesized to predict better outcome scores at 1 year. This is a secondary data analysis of a longitudinal cohort study. Eighty-seven children and youths were assessed with self and proxy report measures of child functioning, family functioning and environmental factors at regular intervals after ABI. Mixed-effects modelling was used to determine individual linear recovery trajectories. Intra-individual variability was defined as the intra-individual standard deviation of the residuals around the recovery line. Less intra-individual variability in recovery predicts better outcomes of physical health (Child Health Questionnaire), behavioural functioning (Strengths and Difficulties Questionnaire), family coping (Impact on Family Scale) and impact of environmental barriers (Craig Hospital Inventory of Environmental Factors). As amount of intra-individual variability increases, outcomes become poorer. Findings support the existence of intra-individual variability in instrument scores over time in this sample and the impact of this variability on several outcomes at 1 year. Potential clinical and research implications are discussed.
Background. Children with developmental coordination disorder (DCD) are often identified by class... more Background. Children with developmental coordination disorder (DCD) are often identified by classroom teachers and the identification process relies heavily on teachers' perceptions. The literature would suggest that teachers' perceptions may be influenced by a child's gender, behaviour and the type of motor problem they demonstrate. To date, the influence of these factors on teachers' perceptions of children with DCD has not been empirically tested.
Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The... more Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59-2.71) and institutional (OR = 1.77; 95% CI: 1.66-1.89) settings. Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.
The purpose of this study was to investigate the effects of aging and the role of augmented visua... more The purpose of this study was to investigate the effects of aging and the role of augmented visual information in the acquisition of a new bimanual coordination pattern, namely a 90 degrees relative phase pattern. In a pilot study, younger and older adults received augmented visual feedback in the form of a real-time orthogonal display of both limb movements after every fifth trial. Younger adults acquired this task over three days of practice and retained the task well over periods of one week and one month of no practice while the older adults showed no improvement at all on the task. It was hypothesized that the amount of augmented information was not sufficient for the older adults to overcome the strong tendency to perform natural, intrinsically stable coordination patterns, which consequently prevented them from learning the task. The present study evaluated the age-related role of augmented visual feedback for learning the new pattern. Participants were randomly assigned within age groups to receive either concurrent or terminal visual feedback after every trial in acquisition. In contrast to the pilot study, all of the older adults learned the pattern, although not to the same level as the younger adults. Both younger and older adults benefitted from concurrent visual feedback, but the older adults gained more from the concurrent feedback than the younger adults, relative to terminal feedback conditions. The results suggest that when learning bimanual coordination patterns, older adults are more sensitive to the structure of the practice conditions, particularly the availability of concurrent visual information. This greater sensitivity to the learning environment may reflect a diminished capacity for inhibitory control and a decreased ability to focus attention on the salient aspects of learning the task.
The incidence of stroke and subsequent level of disability will increase since age is the greates... more The incidence of stroke and subsequent level of disability will increase since age is the greatest risk factor for stroke and the world's population is ageing. Hospital admissions are too brief for patients to regain necessary function. Research to examine therapy delivered within the home environment has the potential to expedite relearning of function and reduce health care expenditures. To use the Knowledge-to-Action Cycle (KTA) to develop and evaluate an evidence-based approach for rehabilitation in the home that incorporates self-management (SM) and task-oriented functional training (TOFT) for persons with stroke in the home. The KTA Cycle was used to guide adaptation of evidence from SM and TOFT into an approach entitled START (Self-Management and Task-Oriented Approach to Rehabilitation Training). Three stakeholder symposiums identified barriers and supports to implementation. Clinical practice leaders were engaged as partners in the development of the intervention. An on...
Objective: To investigate the contributions of physiotherapy and occupational therapy to self-man... more Objective: To investigate the contributions of physiotherapy and occupational therapy to self-management interventions and the theoretical models used to support these interventions in chronic disease. Data sources: We conducted two literature searches to identify studies that evaluated self-management interventions involving physiotherapists and occupational therapists in MEDLINE, the Cochrane Library, CINAHL, EMBASE, AMED (Allied and Complementary Medicine), SPORTdiscus, and REHABDATA databases. Study selection: Four investigator pairs screened article title and abstract, then full text with inclusion criteria. Selected articles (n = 57) included adults who received a chronic disease self-management intervention, developed or delivered by a physiotherapist and/or an occupational therapist compared with a control group. Data extraction: Four pairs of investigators performed independent reviews of each article and data extraction included: (a) participant characteristics, (b) the self-management intervention, (c) the comparison intervention, (d) outcome measures, construct measured and results. Data synthesis: A total of 47 articles reported the involvement of physiotherapy in self-management compared with 10 occupational therapy articles. The type of chronic condition produced different yields: arthritis n = 21 articles; chronic obstructive pulmonary disease and chronic pain n = 9 articles each. The theoretical frameworks most frequently cited were social cognitive theory and self-efficacy theory. Physical activity was the predominant focus of the self-management interventions. Physiotherapy programmes included disease-specific education, fatigue, posture, and pain management, while occupational therapists concentrated on joint protection, fatigue, and stress management. Conclusions: Physiotherapists and occupational therapists make moderate contributions to selfmanagement interventions. Most of these interventions are disease-specific and are most frequently based on the principles of behaviour change theories.
Neurorehabilitation and neural repair, Jan 12, 2014
Although task-related walking training has been recommended after stroke, the theoretical basis, ... more Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke. To compare the impact of a motor-learning-science-based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset. In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. Th...
The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guid... more The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence.
A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) ... more A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) is the learning and relearning of motor skills. Therapists can apply theoretically derived and evidence-based motor learning strategies (MLSs) to structure the presentation of a task and organize the environment in ways that may promote effective, transfer-oriented practice. However, little is known about how MLSs are used in physical therapy interventions for children with ABI. The purpose of this study was to develop and validate an observer-rated Motor Learning Strategy Rating Instrument (MLSRI) quantifying the application of MLSs in physical therapy interventions for children with ABI. A multi-stage, iterative, item generation and reduction approach was used. An initial list of MLS items was generated through literature review. Seven experts participated in face validation to confirm item comprehensiveness. In a content validation process, 12 physical therapists with pediatric ABI experience responded to a questionnaire evaluating feasibility and importance of items. Six physical therapy sessions with clients with ABI were videotaped at a children's rehabilitation center. The 12 physical therapists participated in a session where they: (1) rated session videos to test the MLSRI and (2) provided verbal feedback. Revisions were made sequentially to the MLSRI based on these processes. The MLSRI was scored during videotape observation rather than being given a live rating, which may be onerous in certain settings and may influence therapist or child behavior. Further reliability investigations will determine whether the 33-item MLSRI is of help in documenting strategy use during intervention, as an evaluation tool in research, and as a knowledge transfer resource in clinical practice.
To identify and describe the application of 3 motor learning strategies (verbal instructions, pra... more To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.
Following earlier work by Mechsner et al. (Nature 414 (2001) 69), the purpose of this experiment ... more Following earlier work by Mechsner et al. (Nature 414 (2001) 69), the purpose of this experiment was to determine the perceptual and motoric contributions to bimanual coordination. Twenty right-handed, healthy, young adults performed continuous, horizontal, linear movements of both upper limbs at frequencies of 1.5 and 2.0 Hz. The goal was to control the spatial-temporal displacement of two flags by coordinating upper limb movements in two perceptual conditions. In a congruent condition, the movement of the flags matched the movement of the upper limbs. In an incongruent condition, the movement of the flags was opposite to the movement of the upper limbs. Measures of error in coordination provided support primarily for a motor view of bimanual coordination, and failed to replicate the earlier findings of Mechsner et al. q 2004 Published by Elsevier Ireland Ltd.
A temporary and/or involuntary stoppage of movement is identifiable in the execution phase of wri... more A temporary and/or involuntary stoppage of movement is identifiable in the execution phase of writing, walking, and turning movements in individuals with Parkinson's disease (PD) and may be referred to as freezing. However, the unpredictability of such akinetic impairments has made it difficult to study experimentally. The present study compared PD and age-matched control groups in their ability to coordinate continuous and simultaneous upper limb movements in trials involving two parts. In the first part of each trial, participants performed either in-phase movements (symmetric, simultaneous movement toward and away from the midline of the body), or anti-phase movements (isodirectional). At the midpoint of the trial, they were signaled by an auditory metronome to execute an intentional and voluntarily switch from the coordination currently being performed to the opposite coordination pattern. In the second half of the trial participants were required to maintain performance in the other coordination mode. All trials were paced by an auditory metronome at one of three different speeds (0.75, 1.25, 1.75 Hz). Measures of temporal coordination (relative phase) indicated that overall, participants with PD required significantly longer periods of time to achieve a switch between coordination patterns compared to healthy controls, and experienced greater difficulty changing from the in-phase to anti-phase mode of coordination. As well, movement stoppage was observed in 53.9% of the in-phase to anti-phase switch trials, but in only 15.5% of the anti-phase to in-phase trials. We conclude that interruptions to movement execution are most common when switching to coordinated movements that impose greater motor demands in individuals with PD.
Continuous coordinated movement of the upper limbs performed at different movement frequencies, a... more Continuous coordinated movement of the upper limbs performed at different movement frequencies, and with different external timing conditions, was examined in individuals with Parkinson's disease (PD) and healthy, age-and gendermatched controls. Participants performed symmetric in-phase movements toward and away from the midline of the body, and isodirectional anti-phase movements at one of three metronome speeds (0.75, 1.25, and 1.75 Hz), and in two different auditory cueing conditions (cue present, cue absent). Measures of relative phase accuracy (absolute mean error) and stability (standard deviation) revealed that individuals with PD performed in-phase movements as well as the controls, while anti-phase movements were performed with greater mean error and vari-ability. The adverse effects of PD on the anti-phase task were also reflected by freezing (8.1% of anti-phase trials) and hypometric deficits (5.1% of anti-phase trials) during movement. None of these PD-related impairments occurred during inphase trials. The overall accuracy or stability of movement coordination was not improved with the presence of external pacing cues, suggesting that although execution impairments of individuals with PD may be dramatically influenced by attention, external cueing does not necessarily improve movement performance.
Abstract The purpose of this paper is to describe the opportunities and challenges in the develop... more Abstract The purpose of this paper is to describe the opportunities and challenges in the development of a research group established to investigate and disseminate knowledge related to aging, mobility and participation. Various aspects of the research group are ...
To determine the relationship between the amount of intra-individual variability in measures of a... more To determine the relationship between the amount of intra-individual variability in measures of abilities and participation throughout the first 8 months of recovery from ABI and outcome scores at 1 year. Greater amounts of intra-individual variability throughout recovery are hypothesized to predict better outcome scores at 1 year. This is a secondary data analysis of a longitudinal cohort study. Eighty-seven children and youths were assessed with self and proxy report measures of child functioning, family functioning and environmental factors at regular intervals after ABI. Mixed-effects modelling was used to determine individual linear recovery trajectories. Intra-individual variability was defined as the intra-individual standard deviation of the residuals around the recovery line. Less intra-individual variability in recovery predicts better outcomes of physical health (Child Health Questionnaire), behavioural functioning (Strengths and Difficulties Questionnaire), family coping (Impact on Family Scale) and impact of environmental barriers (Craig Hospital Inventory of Environmental Factors). As amount of intra-individual variability increases, outcomes become poorer. Findings support the existence of intra-individual variability in instrument scores over time in this sample and the impact of this variability on several outcomes at 1 year. Potential clinical and research implications are discussed.
Background. Children with developmental coordination disorder (DCD) are often identified by class... more Background. Children with developmental coordination disorder (DCD) are often identified by classroom teachers and the identification process relies heavily on teachers' perceptions. The literature would suggest that teachers' perceptions may be influenced by a child's gender, behaviour and the type of motor problem they demonstrate. To date, the influence of these factors on teachers' perceptions of children with DCD has not been empirically tested.
Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The... more Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59-2.71) and institutional (OR = 1.77; 95% CI: 1.66-1.89) settings. Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.
The purpose of this study was to investigate the effects of aging and the role of augmented visua... more The purpose of this study was to investigate the effects of aging and the role of augmented visual information in the acquisition of a new bimanual coordination pattern, namely a 90 degrees relative phase pattern. In a pilot study, younger and older adults received augmented visual feedback in the form of a real-time orthogonal display of both limb movements after every fifth trial. Younger adults acquired this task over three days of practice and retained the task well over periods of one week and one month of no practice while the older adults showed no improvement at all on the task. It was hypothesized that the amount of augmented information was not sufficient for the older adults to overcome the strong tendency to perform natural, intrinsically stable coordination patterns, which consequently prevented them from learning the task. The present study evaluated the age-related role of augmented visual feedback for learning the new pattern. Participants were randomly assigned within age groups to receive either concurrent or terminal visual feedback after every trial in acquisition. In contrast to the pilot study, all of the older adults learned the pattern, although not to the same level as the younger adults. Both younger and older adults benefitted from concurrent visual feedback, but the older adults gained more from the concurrent feedback than the younger adults, relative to terminal feedback conditions. The results suggest that when learning bimanual coordination patterns, older adults are more sensitive to the structure of the practice conditions, particularly the availability of concurrent visual information. This greater sensitivity to the learning environment may reflect a diminished capacity for inhibitory control and a decreased ability to focus attention on the salient aspects of learning the task.
The incidence of stroke and subsequent level of disability will increase since age is the greates... more The incidence of stroke and subsequent level of disability will increase since age is the greatest risk factor for stroke and the world's population is ageing. Hospital admissions are too brief for patients to regain necessary function. Research to examine therapy delivered within the home environment has the potential to expedite relearning of function and reduce health care expenditures. To use the Knowledge-to-Action Cycle (KTA) to develop and evaluate an evidence-based approach for rehabilitation in the home that incorporates self-management (SM) and task-oriented functional training (TOFT) for persons with stroke in the home. The KTA Cycle was used to guide adaptation of evidence from SM and TOFT into an approach entitled START (Self-Management and Task-Oriented Approach to Rehabilitation Training). Three stakeholder symposiums identified barriers and supports to implementation. Clinical practice leaders were engaged as partners in the development of the intervention. An on...
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Papers by Laurie Wishart