Stooping and crouching (SC) postures are integral to many daily tasks, such as retrieving objects from the floor and reaching to low shelves, yet nearly one in four community-dwelling older adults (24%) report having difficulty or being completely unable to perform SC movements. While limited research has identified physical (e.g., lower extremity strength and joint immobility) and behavioural (e.g., obesity and balance confidence) determinants of SC difficulty, little is known about how aging affects the manner in which SC tasks are performed. The objective of this thesis was to describe age-related differences in movement kinematics and balance control during stooping and crouching tasks. Healthy younger (n = 12) and older (n = 12) participants performed a series of object-retrieval tasks ??? varying in initial lift height, precision required, and duration ??? that required them to bend over or reach toward the floor. In addition to kinematic and postural control measures describing the movements, measures of lower limb isometric strength, passive range of motion (ROM), and balance confidence were obtained for each participant. Compared to younger, older participants moved slower into and out of self-selected postures, which were characterized by higher whole-body centre of mass (COM) vertical positions. Specifically, older adults exhibited lower vertical COM linear velocities and lower hip, knee, and ankle joint angular velocities during transitions, and higher COM heights achieved through comparatively less flexion in the hip, knee, and ankle joints during object retrieval. Older participants also displayed smaller, more centralized anterior-posterior (AP) COM excursions and lower COM velocities, but higher centre of pressure (COP) activity compared to younger participants, demonstrated through increased COP velocity (relative to COM velocity) and more frequent COP adjustments aimed at regulating COM position. Changing task constraints (i.e., lower initial lift height or longer duration) elicited greater postural changes in younger compared to older participants, potentially reflecting a diminished ability in older adults to make appropriate task-specific adaptations. In particular, younger participants were 4 times more likely than older participants to use a lower to the floor, forefoot crouching posture, especially during longer duration tasks. Older participants also had decreased leg strength and less passive range of motion compared to younger participants. Overall, the results of this thesis demonstrate that despite moving slower through shorter distances, older adults displayed higher COP activity, which may have reflected a heightened effort to control COM position, during SC tasks. This compliments existing works describing age-related differences in movement strategies and balance control during lifting and sit-to-stand tasks. Further work exploring relationships between specific physiological and behavioural factors and SC task performance measures is needed to inform therapeutic intervention strategies.

Recent research indicates the need for a functional balance assessment in cardiac rehabilitation (CR) programs. One assessment technique that may be appropriate is the Community Balance and Mobility Scale (CBMS). The purpose of this study was to investigate psychometric properties of the CBMS when testing patients with cardiovascular disease (CVD). Thirty-one participants from community CR programs were recruited to perform the CBMS and measures of computerized dynamic posturography. Convergent validities between the measures were investigated using correlation coefficients, and floor and ceiling effects of the CBMS were analysed. The results indicated that the CBMS was moderately correlated with all computerized posturography variables, with no floor or ceiling effects present. Analysis of posturography results indicated that CR patients have decreased movement characteristics in the anterior and posterior directions. These findings indicate that the CBMS is a suitable tool to assess and monitor balance in a CR population.

Acquired Brain Injury (ABI) can cause balance and mobility deficits with activity and participation limitations. Repetitive Functional Task Practice (RFTP), currently best practice to promote recovery, is often not delivered at an adequate volume due to limited resources. This case series looked at the feasibility of treating community-dwelling people with ABI, in a group format, thus allowing economical, intense rehabilitation. Four participants attended for four weeks, three days/week, 4.25 hours/day. One-to-one and semi-supervised therapy was delivered with one therapist and one assistant. 89.51 minutes of RFTP and 134.82 minutes of total physical therapeutic activity was delivered per day. Participant satisfaction was good. All participants improved on some clinical measures. Three participants improved single and dual-task balance measures. This project established feasibility, allowed the formation of guiding principles for and supported the value of future research and development of this ABI Boot Camp model. / February 2016

Background: People who have experienced a moderate or severe traumatic brain injury (TBI) will most likely live with motor and cognitive deficits including balance and poor mobility. These deficits may lead to limitations in activity participation, life satisfaction, and may increase the risk of falls. Improving access to rehabilitation care in the chronic phase of recovery is essential to prevent ongoing health issues. However, geographical restrictions, cost of transportation, or recently the COVID-19 pandemic restrictions may limit access to rehabilitation services. Telerehabilitation could serve as an alternative method to provide rehabilitation care while increasing access. Objectives: The overall objective of this dissertation was to understand the implementation of high-intensity telerehabilitation exercise programs for people living with a moderate or severe TBI and their family partners. This was accomplished by 1) determining the feasibility of using telerehabilitation, 2) investigating the effectiveness of high-intensity home-based telerehabilitation exercise programs on physical activity, functional mobility and dynamic balance, 3) understanding the perspectives and lived experiences of completing a telerehabilitation program, and 4) exploring how interpersonal behaviours can influence practice and be perceived in a telerehabilitation setting. Methodology: Influenced by a people-centered approach and explained by the Self-Determination Theory, this dissertation followed a mixed-method alternating single-subject design methodology. Five dyads composed of five persons living with a moderate or severe TBI and their family partners completed two high-intensity telerehabilitation programs remotely supervised, daily and weekly. The feasibility and effectiveness of the telerehabilitation programs were measured from a quantitative and qualitative perspective to replicate the clinical realities and understand all perspectives. Results: In this dissertation, the feasibility of using telerehabilitation with this population was highlighted by reporting high adherence, high usability, active engagement and safety. The effectiveness on physical activity levels, functional mobility, dynamic balance and concerns with falling was also demonstrated with no differences between the daily and weekly remote supervision schedule. The dyads described being highly satisfied, engaged, and enjoyed the remotely supervised exercise programs. The individuals with the TBI perceived more supportive behaviours than thwarting behaviours from the physiotherapist. Conclusion: This dissertation advances knowledge on telerehabilitation implementation for people living with cognitive and motor deficits following a TBI. High-intensity home-based telerehabilitation programs were shown to be feasible and effective. I introduced the importance of assessing needs-supportive and needs-thwarting interpersonal behaviours in the telerehabilitation context. Integrating these novel telerehabilitation concepts within emerging telerehabilitation models of care could significantly impact long-lasting positive health outcomes for individuals living with a moderate or severe TBI.