Individuals with Multiple Sclerosis commonly use assistive mobility devices, such as rollators, to compensate for their mobility impairments. However, the effect of these devices on their foot placement during gait has not been explored in the community. The objective of experiment one was to develop and validate a tool that quantifies medio-lateral foot placement characteristics during rollator use. In this study, a technique was developed for an instrumented rollator (i.e. iWalker) and validated against a Vicon motion capture system in able-bodied young adults. The two systems were in strong agreement. The objective of experiment two was to apply this iWalker-based technique to individuals with Multiple Sclerosis to identify environment-related foot placement changes. This study revealed that step width variability, but not step width, can be influenced by certain outdoor environments. Therefore, environmental context is important to consider when investigating user-device interactions and factors responsible for safe mobility in this population.

This qualitative study investigated the experiences of family caregivers who cared for a stroke survivor throughout weekend passes from an in-patient rehabilitation facility. Following a Husserlian phenomenological perspective, I interviewed 15 family caregivers of stroke survivors on two separate occasions: within one week after their first scheduled weekend pass, and again two weeks after their final transition home. Interviews followed a semi-structured interview guide, and were audio recorded. Interviews were transcribed verbatim, and analyzed using the principles outlined by Giorgi (1997). Analysis of the caregivers’ descriptions of their experiences led to five themes: (i) Caregivers feel overwhelmed throughout the weekend pass, (ii) Access to supportive resources influences caregiving experiences, (iii) Caregivers adjust to the weekend pass throughout its subsequent use, (iv) Caregivers feel a responsibility and a need to be included by health professionals in the care of their family stroke survivor, and (v) Caregivers describe the weekend pass as a means towards recovery. This study has implications for future health services. By appropriately training and supporting caregivers throughout the weekend pass health care professionals can increase the positive experiences of caregivers, and optimize the opportunity to prepare caregivers and stroke survivors for the eventual transition home.

Occupational therapists assess and make recommendations for modifying home environments to facilitate caregiving of children in their homes. Children who are profoundly and permanently physically disabled remain dependent for their care throughout their lifespan. As they mature, the physical demands on family members to provide care become more challenging requiring major modifications to ease caregiving. Qualitative interview data of ten educationally influential occupational therapists (EIOTs) were collected to examine what information the EIOTs collect and how they prioritize and organize these data to make modification recommendations. The data were analyzed using grounded theory methodology. The findings detail myriad information required by the EIOT to make recommendations for modifications. Findings suggest a future oriented and highly contextualized information gathering process. The themes were integrated into a process model that suggests how therapists may be developing recommendations. The findings highlight important implications for research, education, clinical practice and service delivery policy.

Individuals with Multiple Sclerosis commonly use assistive mobility devices, such as rollators, to compensate for their mobility impairments. However, the effect of these devices on their foot placement during gait has not been explored in the community. The objective of experiment one was to develop and validate a tool that quantifies medio-lateral foot placement characteristics during rollator use. In this study, a technique was developed for an instrumented rollator (i.e. iWalker) and validated against a Vicon motion capture system in able-bodied young adults. The two systems were in strong agreement. The objective of experiment two was to apply this iWalker-based technique to individuals with Multiple Sclerosis to identify environment-related foot placement changes. This study revealed that step width variability, but not step width, can be influenced by certain outdoor environments. Therefore, environmental context is important to consider when investigating user-device interactions and factors responsible for safe mobility in this population.

This thesis explores the physiologically-mediated interactions between children with profound disabilities and their environment. Using a structure inspired by the musical theme and variation compositional form, the concept of using physiological signals to enrich person-environment interaction will be addressed in two themes. The first theme explores how children with profound disabilities can use their physiological signals to interact with their environment. The variations on this theme: 1) appraise the literature and establish that peripheral autonomic nervous system signals can be controlled by mental activities; 2) present an algorithm that classifies an individual’s mental state using patterns of electrodermal activity to an accuracy of over 80%, and; 3) discusses the challenges with and potential solutions to creating an physiologically-based interaction pathway for children with profound disabilities. The second theme explores how physiological signals can be used to assess the effect of the environmental milieu on a child with profound disabilities. The variations on this theme: 1) demonstrate the effects of the built environment on the life activities of a severely disabled individual by developing and evaluating the effects of a custom-tailored computer access technology; 2) illustrate how the physiological signals of profoundly disabled children are influenced by their social environment by studying the effect of Therapeutic Clowns on children in a long-term rehabilitation setting; and 3) illustrate how differential physiological responses to sounds in the environmental milieu can be used to inform and improve voluntary physiologically-mediated person-environment interaction. The coda of the thesis presents a conceptual framework that has the potential to enrich the interaction between profoundly disabled children and their environment, using music generated from physiological signal patterns to modify their environmental milieu, constructs of personhood and their identity.

This thesis examines hospitalizations for ambulatory care sensitive conditions among persons with an intellectual disability living in Manitoba from 1999 to 2003. Hospitalizations for ambulatory care sensitive conditions are considered an indicator of access to, and the quality of, primary care. Intellectual disability can be defined as a disability originating before age 18 characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. Between 1 and 3% of the population has an intellectual disability. This thesis addressed three objectives: 1) To identify ambulatory care sensitive conditions that are applicable to persons with an intellectual disability; 2) To compare hospitalization rates for ambulatory care sensitive conditions between persons with and without an intellectual disability in Manitoba; 3) To identify factors associated with hospitalizations for ambulatory care sensitive conditions among adults with an intellectual disability living in Manitoba. An online survey of primary care providers with experience working with persons with an intellectual disability found consensus on fifteen ambulatory care sensitive conditions applicable to persons with an intellectual disability. Large discrepancies in hospitalization rates for these conditions were found between persons with and without an intellectual disability. Controlling for age, year, sex, and region, persons with an intellectual disability were 6 times more likely to be hospitalized for an ambulatory care sensitive condition. Future research should investigate reasons for the large discrepancy in rates between persons with and without an intellectual disability. Among adults with an intellectual disability, living in a rural area (odds ratio 1.3; 95% CI=1.0, 1.8), living in an area with a high proportion of First Nations people (odds ratio 2.3; 95% CI=1.3, 4.1), and experiencing higher levels of comorbidity (odds ratio 25.2; 95% CI=11.9, 53.0) were all associated with a higher likelihood of being hospitalized for an ambulatory care sensitive condition. Dwelling in higher income areas had a protective effect (odds ratio 0.56; CI=0.37, 0.85). The results suggest that addressing the socioeconomic problems of poorer areas and specifically areas densely populated by First Nations people would likely have an impact on hospitalizations for ACS conditions for persons with an intellectual disability.

In contrast to cardiac rehabilitation (CR) programs, traditional stroke rehabilitation aims to maximize functional independence and does not have a strong focus on exercise training and risk factor modification. Given the parallels between stroke and heart disease in cardiovascular etiology and risk factors, CR may be suited to supplement stroke rehabilitation by providing opportunities to enhance fitness and manage stroke risk factors. The aim of this work was to 1) examine the use of a non-adapted CR program of care with individuals with stroke and/or transient ischemic attack (TIA) through a retrospective database review, 2) using a prospective trial, determine the feasibility and effects of an adapted CR program for people with mild to moderate impairment from stroke, and 3) explore characteristics related to degree of program response in aerobic and functional capacity through secondary data analysis. The results from Study 1 demonstrated that traditional CR is an underutilized service for individuals with stroke or TIA, yet improvements in aerobic fitness were comparable to their non-stroke counterparts. In Study 2, adapted CR was feasible for individuals with a range of stroke-related disability and effective in increasing aerobic capacity. The anticipated carry over to improved walking capacity was not observed. There were no changes in health-related quality of life or stroke risk factors. Study 3 identified subgroups of participants who improved or declined in aerobic and ambulatory capacity after the adapted CR program. There were no differences in baseline characteristics, indices of time, intensity or volume of exercise performed across the response subgroups. In summary, given the parallels between stroke and heart disease, the needs of the stroke population and dearth of community-based exercise programming available for them, the CR model of care may be applied for individuals with stroke to provide opportunities for exercise training and risk factor modification.

This thesis explores the physiologically-mediated interactions between children with profound disabilities and their environment. Using a structure inspired by the musical theme and variation compositional form, the concept of using physiological signals to enrich person-environment interaction will be addressed in two themes. The first theme explores how children with profound disabilities can use their physiological signals to interact with their environment. The variations on this theme: 1) appraise the literature and establish that peripheral autonomic nervous system signals can be controlled by mental activities; 2) present an algorithm that classifies an individual’s mental state using patterns of electrodermal activity to an accuracy of over 80%, and; 3) discusses the challenges with and potential solutions to creating an physiologically-based interaction pathway for children with profound disabilities. The second theme explores how physiological signals can be used to assess the effect of the environmental milieu on a child with profound disabilities. The variations on this theme: 1) demonstrate the effects of the built environment on the life activities of a severely disabled individual by developing and evaluating the effects of a custom-tailored computer access technology; 2) illustrate how the physiological signals of profoundly disabled children are influenced by their social environment by studying the effect of Therapeutic Clowns on children in a long-term rehabilitation setting; and 3) illustrate how differential physiological responses to sounds in the environmental milieu can be used to inform and improve voluntary physiologically-mediated person-environment interaction. The coda of the thesis presents a conceptual framework that has the potential to enrich the interaction between profoundly disabled children and their environment, using music generated from physiological signal patterns to modify their environmental milieu, constructs of personhood and their identity.

The factors that influence gait velocity post-stroke are not clearly understood. This thesis sought to uncover the factors associated with gait velocity, particularly those related to maximum velocity. The first of two studies investigated the associations between physical factors and preferred and maximum gait velocity. Analysis revealed that individuals with stroke were able to increase gait velocity from preferred and that this increase, along with the achieved velocity, were related to functional balance. The second study characterized the strategy individuals used to increase gait velocity, and compared between the stroke and healthy population. It also probed the relationships between cadence, step length, strategy, and post-stroke impairment. This study demonstrated that individuals with stroke rely more on cadence than step length to increase gait velocity. These results revealed the role of balance control on limiting gait velocity and the need for specific measures of impairment in research to direct clinical practice.

The factors that influence gait velocity post-stroke are not clearly understood. This thesis sought to uncover the factors associated with gait velocity, particularly those related to maximum velocity. The first of two studies investigated the associations between physical factors and preferred and maximum gait velocity. Analysis revealed that individuals with stroke were able to increase gait velocity from preferred and that this increase, along with the achieved velocity, were related to functional balance. The second study characterized the strategy individuals used to increase gait velocity, and compared between the stroke and healthy population. It also probed the relationships between cadence, step length, strategy, and post-stroke impairment. This study demonstrated that individuals with stroke rely more on cadence than step length to increase gait velocity. These results revealed the role of balance control on limiting gait velocity and the need for specific measures of impairment in research to direct clinical practice.