<p>Appendices include current drafts of the Hamilton Inventory for Complex Regional Pain Syndrome and the associated user manual for the assessment tool.</p> / <p>Complex regional pain syndrome is a neurological condition characterized by a constellation of variable and seemingly disparate signs and symptoms for which there is presently no definitive diagnostic test. The opportunity exists for development of a condition-specific outcome measure for complex regional pain syndrome affecting any limb(s) that could be used by therapists, physicians and researchers to evaluate their patients, make treatment decisions, and monitor the changes in both impairments and quality of life experienced by those affected individuals. This thesis addresses outcome assessment in complex regional pain syndrome, incorporating 2 papers. The first is a systematic review of the current scope and psychometric rigor of outcome assessments available to health professionals to guide their management of this condition. The second paper describes the preliminary development steps of a new measurement tool for complex regional pain syndrome, with a focus on a cognitive debriefing study of current assessment practices and preferences of a cross-section of health professionals used to inform the definitions and user manual for a multi-disciplinary assessment. Finally, the thesis addresses areas for future refinement and testing of the proposed outcome measure.</p> / Master of Science (MSc)

Kinesio® Tape was invented in 1973, and since has been used in various clinical and therapy settings to prevent and heal a multitude of physical conditions. Kinesio® Tape is a 100% cotton-based elastic tape that when applied to the skin pulls the skin upwards and creates more space by lifting the fascia and soft tissue, thus increasing blood flow and decreasing edema. The tape was also purported to facilitate the strengthening of weakened muscles through neuromuscular facilitation. The objective behind this study was to determine the long-term effects of applied forearm Kinesio® Tape on maximal grip strength when paired with an exercise program. The study took place at the CMS Athletic Training Center, and was designed to be a matched-pairs, single group, repeated measures experiment. Thirty- two healthy members of the Claremont College community voluntarily participated in this study. There was 16 male and 16 female participants (average age: 21.46 ± 1.76 years; average height 174.92 ± 9.40 cm; average body weight 69.17 ± 9.20 kg). The maximal grip strength of both the dominant and non-dominant hands was measured using a JAMAR Hydraulic Hand Dynamometer. Each of the 32 subjects also participated in an exercise program for two weeks and provided a grip strength measurement at the end of each week. Maximal grip strength values were assessed using a standard paired-samples t-test. Results revealed a significant difference in grip strength in the dominant arm (exercise with Kinesio® Tape) compared to the non-dominant arm (exercise only). When combined with a relatively low to medium level exercise program, Kinesio® Tape significantly increased grip strength when compared to an exercise program alone in a healthy population.

<p><strong>Objectives: </strong>To assess the reliability and validity of the Patient Specific Functional Scale when administered to people living with Parkinson’s Disease.<strong></strong></p> <p><strong>Methods and Materials: </strong>Twenty six people living with Parkinson’s Disease from Hamilton and Burlington were interviewed four times within a four month period. The participants answered the Movement Disorders Sponsored Unified Disease Rating Scale part II, the Parkinson’s Disease Questionnaire 39, and the Patient Specific Functional Scale. Reliability assessment addressed test-retest reliability and reliability of the change scores using Intraclass Correlation Coefficients. Validity assessment focused on convergent construct validity and longitudinal validity by correlating the Patient Specific Functional Scale with the other measures administered.</p> <p><strong>Results: </strong>The<strong> </strong>test retest reliability of the scores yielded by the PSFS was ICCpre= 0.72 (95%CI=0.47-0.86); ICCpost=0.83 (95%CI=0.66-0.92). The reliability of change scores was 0.50. In relation to the validity, no significant correlations were found between the Patient Specific Functional Scale and the other measures. <strong></strong></p> <p><strong>Conclusions: </strong>The PSFS yields reliable scores when it is administered to people living with PD. The Patient Specific Functional Scale does not target the same outcomes as the MDS-UPDRS part II and the PDQ-39. The PSFS does not detect change in functioning in people living with PD within a four month period.</p> / Master of Science (MSc)

<p><strong>Background: </strong>Total joint arthroplasty (TJA) is considered the treatment of choice to alleviate pain and improve function of patients with osteoarthritis. However,recent evidence suggests that a significant proportion of patients continue to report pain, or worsening of their symptoms well after their joint replacement. We call this chronic pain “<em>phantom joint pain</em>” as it persists despite the fact hat the affected joint has been replaced.</p> <p>Chronic pain of neuropathic origin may be a consequence of surgery or in patients with osteoarthritis (OA); there may be a combination of nociceptive and neuropathic pain (NP) mechanisms. As there are no definitive physiological indicators for NP or gold standards for diagnosis, Guidelines on Neuropathic Pain Assessment advocate the use of screening tools to evaluate the patient’s pain experiences and potentially characterize various pain features.</p> <p>Despite suggestions that phantom joint pain post TJA is a common problem there is limited information about its prevalence among Canadians. To date there are no studies that have characterized neuropathic vs. non- neuropathic chronic pain features in a TJA population.</p> <p><strong>Purpose: </strong>The purpose of this work was to determine the<em> </em>prevalence of chronic pain following total hip (THA) or knee (TKA) arthroplasty, and to identify the proportion of the cohort with chronic pain whose symptoms suggested the pain was of neuropathic origin. In addition we evaluated the ability of the NP Subscale of the McGill pain questionnaire [NP-MPQ (SF-2)] to identify individuals with NP vs. Non NP in the TJA population.</p> <p><strong>Methods:</strong> A retrospective cohort study (2-4 years post joint replacement) of 148 participants with primary unilateral TJAidentified from a large joint arthroplasty database (n=1143). Chronic pain was defined as post surgical pain reported 6-12 months following surgery to be 3 or higher (out of 5) on the Oxford Hip/Knee Scores, and that pain was the same or worse than reported preoperatively. A postal survey was used to administer the NP-MPQ (SF-2)and the Self-Administered Leeds Assessment of Neuropathic Signs and Symptoms (S–LANSS) (1.5-3.5 years post TJA). S-LANSS was the “non reference standard” for classification of neuropathic pain. Human research ethics approvals from Sunnybrook Health Sciences Centre and McMaster University/Hamilton Health Sciences were obtained prior to the study.</p> <p><strong>Results</strong>: The response rate to the postal survey to identify those with chronic pain of neuropathic origin was 53%. Thirteen percent of individuals experienced chronic pain; among individuals with chronic pain, neuropathic subtype was found in 28% (S-LANSS ≥ 12) - 43% [NP-MPQ (SF-2) ≥ 0.91]. Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) yielded an area under the curve of 0.89 (95% CI: 0.82, 0.97). A cut off score of 0.91 NP-MPQ (SF-2),<strong> </strong>maximized sensitivity (89.5%) and specificity (75.0%). Our results revealed moderate correlation (r=0.56; 95% CI: 0.40, 0.68) between the S-LANSS and NP-MPQ (SF-2)scores in patients with NP post TJA.</p> <p><strong>Conclusion: </strong>Based on our results, a considerable percentage of individuals (13%) experience chronic pain following TKA and THA. Moreover, among individuals with chronic pain symptoms, a significant proportion (28-43%) of those experience pain that appears to have a neuropathic component, even 1.5 to 3.5 years following surgery.Overall prevalence of NP in TJA was 3.3 to 4.5%. The NP-MPQ (SF-2)subscale demonstrated “good” discriminatory ability, thus it might be useful in identifying patients with NP following TJA. Moderate association exists between the scales and this could affect prevalence rates in studies; or diagnosis of NP of individual patients based on the criterion used.</p> / Master of Science (MSc)

With a large population of people who suffer from aphasia, it is imperative that an effective form of therapy is utilized. The purpose of this study was to investigate the effectiveness of augmentative and alternative communication (AAC) programs in improving the communication needs and lives of people affected by aphasia. Individuals (n = 20) suffering from aphasia for 3 months or more completed therapy sessions with speech and language pathologists and the AAC program. Pre- and post-intervention evaluations were administered, consisting of communication satisfaction and success questionnaires, the Western Aphasia Battery (WAB), and probing tests (prompt and response) with an EEG component. Only preliminary data analyses were completed, on three individuals, due to setbacks. All individuals improved on their post-WAB score and average scores on the questionnaires generally increased, but none were statistically significant. However, clinicians noted a clinical significance in improvements, which suggests that AACs are beneficial in aiding and improving people’s communicative functions and daily life. Resting state EEG data of one subject exhibited high mean power spectral densities (PSD) for delta and theta bands in the lobes before and after therapy, supporting previous literature. Mean PSDs of the left frontal lobe demonstrated a statistically significant decrease from pre- to post-, which in the case of the delta and theta bands may indicate possible recovery. More research is necessary to substantiate these conclusions and to explore the use of EEG in mapping brain lesions and tracking the brain’s rehabilitation, as well as the benefits of AACs.

This study seeks to: (1) determine if differences exist between children with Specific Language Impairment (SLI) compared to age-matched (AM) and language- matched (LM) children with typical language development (TL) in rates and proportions of five types of metalinguistic productions and (2) test theories of metalinguistic production. Forty-five children, 24 with TL and 21 with SLI, paired for age or language level, formed two groups. Previously collected data from two studies of verb learning (Proctor-Williams & Fey, 2007; Proctor- Williams, unpublished) were analyzed for rates and types of metalinguistic productions. Results yielded no within or between group significant differences in the rates types. There were differences in proportional use of types of metalinguistic utterances in the LM group. This study showed that children as young as 3;0 produce metalinguistic utterances. Further, it disproved the Piagetian-Based Metalinguistic Development Theory. Interesting trends suggest direction for future research.

Objective. The objective of this study was to evaluate a 10-week Taiji intervention to a 10-week strength training intervention in terms of their ability to relieve osteoarthritis (OA) symptoms, alter gait, and improve mobility in seniors with knee OA. Methods. Men and women between the ages of 60 and 85 years who met the American College of Rheumatology criteria for knee OA were recruited to participate in either a simplified Taiji program (n=12), an open-chain strength training program (n=13), or a control group (n=6). All participants completed the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC), three physical performance tests, and a 3-D gait analysis at baseline and again after the 10-week intervention. Results. The strength training group significantly improved on the time up-and-go test (p = 0.001), the WOMAC pain sub-score (p=0.006), WOMAC stiffness sub-score (p<0.001), and WOMAC physical function sub-score (p=0.011). The Taiji group significantly improved on the timed up-and-go (p<0.001), but there was no change in their WOMAC scores. Neither group showed any significant changes in either kinematic or kinetic gait variables. Conclusion. Strength training was effective for improving mobility and improving the symptoms of knee OA. Taiji was also effective for improving mobility, but did not improve the participants‟ knee OA symptoms. Neither intervention had an effect the participants walking gait.

Human locomotion is phenomenon that is extraordinarily complex. It is evident that a complete description of locomotion involves consideration of kinematics, kinetics, and muscle activity of the extremities in all of their various movements. Race walking (RW) is a form of upright locomotion that differs from normal walking and running by its form dictated by the International Amateur Athletics Federation (IAAF). Despite the similarities to both normal walking (NW) and running (RU), RW has not been the subject of equally intensive investigations. This study explores the comprehensive biomechanics of race walking and how it compares to NW and RU. A quantitative approach was used to evaluate kinematic, kinetic and muscle activity variables between race walking and both normal walking and running. A cross-sectional, laboratory design was used on 15 recreationally competitive race walkers to evaluate these variables. Based on the results of this study, RW is an intermediate gait between NW and RU that has characteristics of both gaits, but is still a unique gait in itself. While there are differences between RW and both RU and NW, some of the expected differences between RW and the two gaits did not occur. Significantly greater frontal plane pelvis-trunk joint range of motion and sagittal plane peak hip flexor and extensor moments, hip joint range of motion and rectus femoris muscle activity contribute to the significant differences in both RW and NW, and RW and RU. Significant differences between RW and RU showed that RU requires more contribution from the trunk, pelvis and lower extremities kinematically and kinetically, as well as increased muscle activation, to execute the motion than RW. Conversely, RW requires more contribution from these variables than NW does, but in not as great a capacity as RU compared to RW. In spite of these findings, there were some variables that had no significant differences between RW and RU. This suggests that injuries during RW are similar to those during RU, but may not occur as frequently.

The goal of the present study was to examine changes in the speech and language performance of patients with chronic, non-fluent aphasia over the course of a three-hour group speech and language treatment session, a time allotment comparable to intensive therapy practices. Nine participants, (three groups of three), with chronic, non-fluent aphasia were seen for a single group therapy session three hours in length. Therapeutic activities were designed to be as similar as possible for each group of participants. Each participant was individually assessed before (time 1), during (time 2), and after (time 3) the group treatment session. Assessments included four verbal tests: function, naming, sentence completion, and repetition, similar to those used with the Porch Index of Communicative Ability (PICA; Porch, 1981). Results indicated that participants performed significantly poorer on two of the four verbal tests (naming and repetition), and on an overall measure of verbal communication on the Time 2 assessment as compared to the Time 1 assessment. Findings have clinical implications for selecting candidates for intensive language therapy regimes.

The consistent increase of cultural diversity and immigration within the United States over the last fifty years has contributed to a societal shift towards a growing bilingual population. The growth of this population has generated a need to evaluate current assessment and treatment plans for bilingual post-stroke aphasia patients within the United States to ensure that these individuals are receiving effective healthcare. This study aims to investigate the current knowledge gap surrounding appropriate methods of assessing and treating bilingual post-stroke aphasia patients within the United States and suggest potential approaches based on existing research. In order to synthesize information regarding current methods of assessing and treating bilingual post-stroke aphasia patients and to suggest areas for future research, a review of previously published literature was conducted. To illustrate the association between bilingualism and approaches to healthcare, potential and previously studied assessment and treatment plans for bilingual post-stroke aphasia patients within the United States were evaluated based on the likelihood of their success in a physical clinical setting. Because minimal research currently exists concerning intervention in bilingual aphasic adults, SLPs in the United States are forced to provide services without the knowledge necessary to provide efficacious healthcare to this population. As a result, there is currently a critical need for the development of consistent, culturally relevant assessments and treatment approaches for bilingual post-stroke aphasia patients and for large-scale empirical studies to be conducted in the United States that examine the validity of these assessment and treatment protocols.