Walking is an essential task important to recovery after stroke. However, there is a limited understanding regarding the characteristics of walking in in-patients with stroke. The objectives of this thesis were to: 1) develop an instrument capable of acquiring temporal characteristics of everyday walking; 2) investigate the quantity and control of everyday walking; and 3) profile the task-specific link between walking and cardiorespiratory response. In study 1 we developed and validated a wireless monitoring system (ABLE system). Study 2 revealed low quantities of everyday walking (4816 steps; SD 3247) characterized by short bout durations (59.8s; SD 23.4) and asymmetric walking. In study 3 we observed a modest task-related response in HR(19.4% HRR); however, the intensity and duration of everyday walking did not approach the guidelines for aerobic benefit. Monitoring in-patient walking can help guide clinical decision making in developing methods to maximize recovery after stroke.

Walking is an essential task important to recovery after stroke. However, there is a limited understanding regarding the characteristics of walking in in-patients with stroke. The objectives of this thesis were to: 1) develop an instrument capable of acquiring temporal characteristics of everyday walking; 2) investigate the quantity and control of everyday walking; and 3) profile the task-specific link between walking and cardiorespiratory response. In study 1 we developed and validated a wireless monitoring system (ABLE system). Study 2 revealed low quantities of everyday walking (4816 steps; SD 3247) characterized by short bout durations (59.8s; SD 23.4) and asymmetric walking. In study 3 we observed a modest task-related response in HR(19.4% HRR); however, the intensity and duration of everyday walking did not approach the guidelines for aerobic benefit. Monitoring in-patient walking can help guide clinical decision making in developing methods to maximize recovery after stroke.

Acquired brain injury (ABI) during adolescence presents even greater challenges to youth already facing complex issues in this transitory period. Studies have demonstrated that youth with ABI suffer from social and community withdrawal as a result of their injuries. However, a lack of research focusing on interventions designed to promote community integration has left the effectiveness of these programs difficult to assess. The current study aimed to collect pilot data about the effectiveness of an expressive arts-based therapeutic program in helping to improve community integration of these youth, as these therapies have been shown to be useful for individuals with similar cognitive and behavioural issues. Results over 2 stages of testing suggest that expressive arts therapy is a promising intervention strategy to help promote social and community integration skills. The findings also suggest that more research is needed to develop improved measures of community integration for adolescents with ABI.

This study furthers our understanding of naturalistic strategy use by ABI survivors with executive dysfunction. Strategies used by 14 stroke survivors, 12 TBI survivors and 25 matched controls on the Baycrest Multiple Errands Test (BMET) were scored. Relationships between strategy use and BMET performance were found for all groups (rs=.30-.71). TBI participants experienced monitoring difficulties (rs=-.38 to -.71). Greater use of task setting strategies was associated with better performance for all participants. Results support the theory of fractionation of the prefrontal lobes and the suggestion for further fractionation of the task setting and monitoring processes. Strategy use was consistently correlated with scores on the AMPS (rs=.30-.75) indicating good ecological validity. Differences in patterns of strategy use between stroke and TBI participants suggest these types of ABIs do not affect real-world performance in the same way. This study indicates the importance of understanding naturalistic strategy use for cognitive rehabilitation after ABI.

Acquired brain injury (ABI) during adolescence presents even greater challenges to youth already facing complex issues in this transitory period. Studies have demonstrated that youth with ABI suffer from social and community withdrawal as a result of their injuries. However, a lack of research focusing on interventions designed to promote community integration has left the effectiveness of these programs difficult to assess. The current study aimed to collect pilot data about the effectiveness of an expressive arts-based therapeutic program in helping to improve community integration of these youth, as these therapies have been shown to be useful for individuals with similar cognitive and behavioural issues. Results over 2 stages of testing suggest that expressive arts therapy is a promising intervention strategy to help promote social and community integration skills. The findings also suggest that more research is needed to develop improved measures of community integration for adolescents with ABI.

This study furthers our understanding of naturalistic strategy use by ABI survivors with executive dysfunction. Strategies used by 14 stroke survivors, 12 TBI survivors and 25 matched controls on the Baycrest Multiple Errands Test (BMET) were scored. Relationships between strategy use and BMET performance were found for all groups (rs=.30-.71). TBI participants experienced monitoring difficulties (rs=-.38 to -.71). Greater use of task setting strategies was associated with better performance for all participants. Results support the theory of fractionation of the prefrontal lobes and the suggestion for further fractionation of the task setting and monitoring processes. Strategy use was consistently correlated with scores on the AMPS (rs=.30-.75) indicating good ecological validity. Differences in patterns of strategy use between stroke and TBI participants suggest these types of ABIs do not affect real-world performance in the same way. This study indicates the importance of understanding naturalistic strategy use for cognitive rehabilitation after ABI.

Objectives: Research literature points to a range of “factors” that are associated with return to work outcomes but little understanding of the experience of workers, the strategies used to adapt, how work shapes and influences adjustment, and the trajectories that describe their return to work experience. The aim of this qualitative, workplace-based study was to characterize workers readaptation to the workplace and develop a substantive framework for return to work following disabling cardiac illness. Methods: The study used a concurrent, nested, mixed methods approach, using grounded theory to inform the sampling and analysis framework. Participant workers were 12 males having suffered occupational disability owing to cardiac illness and returning to work at a large auto manufacturing plant. Participants were purposefully sampled for a range of disease and disability experiences as well as a range of work roles in the plant. Data were derived from semi-structured in-depth interviews, standardized questionnaire measures of health-related quality of life and work limitations, observations within the plant, and extensive field notes and memos. Longitudinal information was obtained through follow-up interviews over a two to ten month period. Results: Participants had a range of illness impacts and representations and fulfilled diverse roles in the plant including assembly jobs and trade work. Thematic analysis revealed that participants used adaptive strategies including changing mindset in relation to work, building physical capacity and efficiency, managing relationships and work schedules, and using supports in the plant. Thematic analysis highlighted the importance of the nature of work, the quality of work relationships, organizational practices around accommodation and supports in the workplace including occupational health support. Conclusions: Worker adaptation following disabling cardiac illness involved a process of self-regulation including elements of illness and work representations, deployment of adaptive strategies to compensate for ongoing impairments, self-monitoring, goal setting and adaptive selection of work activities. Work demands, relationships and structures provide a range of possibility for self-regulation and quality of life. Implications for practice for work and health researchers and professionals as well as potential linkages to theory are discussed.

The rollator is a mobility aid commonly used to facilitate balance and mobility for individuals with cardiorespiratory, musculoskeletal, or neurological deficits. Despite its popularity, there are also reports of adverse effects related to walker use linked to increased fall risks. Studies examining the effectiveness and consequences of rollator use have employed standard laboratory-based measurement methods that rely on performing specific tasks within a short time period and under controlled conditions, potentially limiting generalization to mobility in the everyday context. An instrumented rolling walker (iWalker) was developed as an ambulatory measurement tool applicable to the assessment of balance outside of the lab or clinic for assistive device users. The iWalker autonomously collects measurements of the upper and lower limb behaviour related to balance, walker kinematics, and video of the immediate spatial environment. The design and development of the iWalker is first described, followed by two studies characterizing the involvement of the upper limbs for balance in standing and walking that served to address gaps in the literature and evaluate the utility of the upper limb measures. Overall, the upper limbs can become the primary effectors of balancing forces when lower limb capabilities are compromised. When lower limb involvement was experimentally constrained, the upper limbs became the primary effectors of balance control in healthy, young adults. In older adults, individuals demonstrating the highest upper limb usage during walking were associated with the largest reduction in frontal plane stepping parameters (i.e., step width). A third study evaluated the applicability of the iWalker to assess everyday mobility in a series of in-patients recovering from neurological injury (i.e., stroke, traumatic brain injury). Patients demonstrated significantly different upper limb balancing behaviour in everyday situations compared to in-laboratory assessments. Furthermore, the iWalker captured behaviours that may be precursors to falling, such as collisions, stumbling and lifting the assistive device. The implications of these studies on assessing the effectiveness of rollators and feasibility of using the iWalker in follow-up efforts are discussed.

The purpose of this thesis was to analyze factors related to labour market survival and withdrawal behaviour in the profession of Occupational Therapy in Ontario from 1997 to 2006. To provide a portrait of the OT labour market in Ontario overall, and in relation to sector and age, three types of analysis were used: descriptive statistics (including “stay, switch, and leave” analysis), “Stickiness” and “Inflow” analysis, and survival analysis. The largest proportion of OTs worked in the Hospital sector, which had a great ability to retain OTs according to the “Stickiness” analysis. However, when controlling for other variables using survival analysis, none of the sector variables had a significant effect on survival. The youngest and oldest age groups had the highest propensity of leave, due to mobility, family commitments, and retiring (oldest group only). Overall, the profession in Ontario had a strong ability to retain OTs working in the profession during the study period.

This thesis reports on a multi-phased research project conducted to evaluate the use of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach with adults with stroke. Current approaches to motor recovery, called systems approaches, suggest that movement arises from a dynamic interaction among several different systems, including perception, cognition, and action, all within the context of the individual and his or her environment. CO-OP is an established treatment approach for children with motor-based performance problems that takes into account interactions among several systems, as well as individual needs and environmental factors. CO-OP is a client-centred, problem solving approach based on the theoretical foundations of learning and motor learning theory. The objectives of this project were: to examine the efficacy of CO-OP to improve motor skill acquisition and performance in adults living with chronic stroke; to explore other benefits of the approach; and to identify adaptations for use with adults with stroke. Two series of single case experimental studies were conducted, with three participants completing each. In addition, semi-structured interviews were conducted. Findings from the single case experiments provide evidence that CO-OP is associated with performance improvements in both trained and untrained self-selected goals in adults more than one year post stroke. As well, pre-post measures suggest there may be changes in performance satisfaction, motor control, generalized use of the affected upper extremity, and self-efficacy. Interview findings provided valuable information about the experiences of participants with the approach; the interview respondents enjoyed the increased sense of responsibility that came with problem solving on their own, but expressed a desire to have ongoing professional support. Suggestions for modifications to CO-OP for use adults with stroke are made. CO-OP is a promising approach to improve functional independence in adults with stroke. Future research is warranted.