Stroke is the major cause of permanent adult disability worldwide. Often stroke affects the motor control of the upper limb, leading to difficulties in performing activities of daily living. Many hours are spent in resource-intensive therapy to regain functionality of the upper limb. In order to decrease the burden to therapists and increase access to rehabilitation, an upper limb rehabilitation robotic device was developed. Observations from therapists and an international survey of stroke therapists were conducted to understand general requirements of an upper limb rehabilitation device. These requirements were the basis of the mechanical design portion of the prototype. The prototype was evaluated with stroke therapists in a focus group. Although more iterations of design, testing and evaluation are needed, this project is a step in developing a lower cost, portable device to increase access to upper limb stroke rehabilitation.

Objective: To describe the walking characteristics of a sample of ambulatory subjects with sub-acute incomplete spinal cord injury (iSCI). Methods: 52 subjects were included in a secondary analysis of clinical and spatiotemporal measures of walking. The study sample was described as a whole and subsequently divided into subgroups on the basis of 3 clinical factors (etiology, severity, and neurological level of injury) and 4 gait factors (gait aid, velocity, symmetry, and variability). Results: Clinical and spatiotemporal parameters were highly variable across the study population. Sub–groups with unique gait features were best identified by velocity and variability. Conclusions: Spatiotemporal measures of walking provide augmented description of walking in the sub-acute iSCI population. Sub-grouping by gait factors warrants further investigation with respect to their ability to act as predictors and modifiers of treatment effect.

The benefits of brief-duration, early exercise programs in stroke have been shown, but the effects of longer-duration aerobic training early after stroke have not been examined. The purpose of this study was to determine the effects of an early aerobic exercise program that extended beyond inpatient into outpatient rehabilitation on aerobic capacity, walking parameters (walking distance, speed, and symmetry), health-related quality of life, and balance. Patients in the subacute phase after stroke (n = 15) with mild to moderate impairment received aerobic exercise in addition to conventional rehabilitation. The study participants demonstrated significant improvement in aerobic and walking capacity, peak work rate, quality of life, balance, and gait velocity from baseline to midpoint. However, no difference was found between midpoint and final. This early aerobic exercise program following stroke significantly improved aerobic capacity, walking ability, quality of life and balance during the inpatient period although no further improvement was observed during the outpatient period.

Introduction: This study explored the health behaviour of older adults with COPD. Objectives included: 1) to explore the process of successfully managing COPD; 2) to identify health behaviour strategies utilized; 3) to identify factors influencing health behaviour change; 4) to understand the impact of pulmonary rehabilitation (PR). Methods: Eleven community-dwelling older adults were interviewed following PR. Interviews were coded and analyzed using constant comparative analysis, comparing and contrasting incoming data with emerging theory. Findings: Two distinct models were developed representing participants’ experience with COPD and health behaviour change: Struggling with Living: Life with COPD before Pulmonary Rehabilitation; and Carrying on with Living: Life with COPD following Pulmonary Rehabilitation. Conclusions: Older adults with COPD engaged in a limited repertoire of health behaviour strategies which were relatively ineffectual prior to participation in PR. PR had a major impact on health behaviour strategies, and on the external and personal factors influencing health behaviour.

Post-stroke fatigue (PSF) is a common yet under-diagnosed and undertreated phenomenon. The unresolved debate over what is PSF has hampered the ability of clinicians to study and develop treatments for this condition. Patients with stroke (n=70) seeking neurorehabilitation at Toronto Rehabilitation Institute completed self-report ratings of fatigue, depressive and anxiety symptoms, and sleepiness. Data were collected from objective measures of stroke topography, sleep disorders, physical fatigability and comorbid medical conditions. A Principal-Components Analysis was performed. Factor 1, the “Distress” factor, was comprised of the all of the self-reported scales i.e. depression, anxiety, fatigue and sleepiness. Factor 2, the “Physical State” factor, was comprised of a diagnosis of Obstructive Sleep Apnea, stroke territory and total medical burden. Factor 3, the “Performance” factor, was comprised by the 6 Minute Walk Test. An orthogonal rotation was the most parsimonious fit to the data, suggesting that the three factors are uncorrelated to each other.

The strength of time-dependent correlations known as stride interval (SI) dynamics have been proposed as an indicator of neurologically healthy gait. Most recently, it has been hypothesized that these dynamics may be necessary for gait efficiency although the supporting evidence to date is limited. To gain a better understanding of this relationship, this study investigated stride interval dynamics, the energy cost of walking, and physical activity in a pediatric population. The findings indicate that differences in energy cost are not reflected in the stride interval dynamics of able-bodied children. Interestingly, increasing physical activity levels were associated with decreasing variance in stride interval dynamics between subjects, though this finding only approached significance (p=0.054). Lastly, this study found that stride interval dynamics in children as young as nine years were comparable to stride interval dynamics found in healthy young adults.

Stroke is the major cause of permanent adult disability worldwide. Often stroke affects the motor control of the upper limb, leading to difficulties in performing activities of daily living. Many hours are spent in resource-intensive therapy to regain functionality of the upper limb. In order to decrease the burden to therapists and increase access to rehabilitation, an upper limb rehabilitation robotic device was developed. Observations from therapists and an international survey of stroke therapists were conducted to understand general requirements of an upper limb rehabilitation device. These requirements were the basis of the mechanical design portion of the prototype. The prototype was evaluated with stroke therapists in a focus group. Although more iterations of design, testing and evaluation are needed, this project is a step in developing a lower cost, portable device to increase access to upper limb stroke rehabilitation.

Objective: To describe the walking characteristics of a sample of ambulatory subjects with sub-acute incomplete spinal cord injury (iSCI). Methods: 52 subjects were included in a secondary analysis of clinical and spatiotemporal measures of walking. The study sample was described as a whole and subsequently divided into subgroups on the basis of 3 clinical factors (etiology, severity, and neurological level of injury) and 4 gait factors (gait aid, velocity, symmetry, and variability). Results: Clinical and spatiotemporal parameters were highly variable across the study population. Sub–groups with unique gait features were best identified by velocity and variability. Conclusions: Spatiotemporal measures of walking provide augmented description of walking in the sub-acute iSCI population. Sub-grouping by gait factors warrants further investigation with respect to their ability to act as predictors and modifiers of treatment effect.

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

Violence and traumatic brain injury (TBI) are two major public health concerns. This thesis is comprised of three different research topics; the epidemiology of intentional TBI in Ontario, discharge against medical advice (DAMA) as an undesirable outcome of acute stage, and functional changes after receiving rehabilitation care. To study these areas, three different datasets from the Canadian Institute for Health Information (CIHI) were used. The first epidemiological study on intentional TBI identified 1,409 (8.0%) intentional TBIs and 16,211 (92.0%) unintentional TBIs. Of the intentional TBIs, 389 (27.6%) were self-inflicted TBI (Si-TBI) and 1,020 (72.4%) were other-inflicted TBI (Oi-TBI). The most common causes of Si-TBI were “jumping from high places” and “firearms”. Major causes of Oi-TBI were ‘fight and brawl” and “struck by objects”. Si-TBI was associated with younger age, female gender, and having a history of alcohol/drug abuse. Oi-TBI was also associated with younger age and having an alcohol/drug abuse history and also with male gender. The second study on discharge against medical advice found that 446 (2.84%) TBI patients left hospitals without medical advice. DAMA was significantly associated with intentional injuries in those with self-inflicted TBI and other-inflicted TBI. DAMA was also associated with younger age and a history of alcohol/drug abuse. Using univariate analyses, the third study found that people with intentional TBI had significantly lower FIM gains in the motor area and significantly lower relative function gains (as measured by Montebello Rehabilitation Factor Score) in the cognitive area. Multivariate analyses of the same data showed that intentional TBI was also associated with lower cognitive relative gains, while controlling for age, gender, alcohol/abuse history, and other demographic and clinical variables. Persons with intentional TBI were found to be less likely to be discharged home, controlling for other relevant confounders. In conclusion, a person who has been injured due to assault or suicidal attempt may need more individualized care as they may be at greater risk for adverse rehabilitation outcomes. These findings regarding people with intentional TBI provide a basis for enhancing efforts on prevention of violence-related TBI and DAMA, and also for improving rehabilitation programs and discharge plans for this vulnerable population.