Purpose: The primary purpose of this study was to determine if a pedometer-driven physical activity (PA) intervention with individualized stepcount goals would be more efficacious in yielding greater amounts of PA than the usual time-based PA recommendations given to maintenance CR patients. Additionally, the secondary purpose of this study was to assess differences in stepcount activity on days attending maintenance CR and on non-rehab days. Methods: Subjects entering maintenance CR for the first referral were recruited for study participation and stratified into pedometer feedback (PF) and usual care (UC) groups. All subjects wore a New Lifestyles NL-1000 pedometer. PF subjects wore the pedometer for the duration of the 8-week study. For comparison, UC subjects wore the pedometer at baseline, week 4, and week 8.Both groups were encouraged to accumulate a minimum of 40 - 50 min/d at moderate intensity when attending maintenance CR. UC subjects were encouraged to follow-up with at least 30 min/d PA outside maintenance CR, while PF subjects were given daily stepcount goals. Stepcount goals were calculated as 10% of baseline stepcounts and added weekly to increase daily goal. All subjects completed a 6- minute walk test at baseline and week 8, and behavioral change questionnaires were completed at baseline, week 4, and week 8. Results: A total of 18 subjects (PF, n = 9, 53.7±8.0; UC, n = 9, 60.2±9.6 yrs) completed the 8-week study. There were no differences between groups at baseline. PF group increased daily stepcounts by week 4 (19%, 1,080±649 steps/d) and 8 (44%, 2,468±846 steps/d) in addition to days attending rehab by week 4 (14%, 1064±45 steps/d) and 8 (36%, 2,711±423 steps/d) and non-rehab days by week 8 (42%, 1,747±759 steps/d). PF subjects accumulated greater daily stepcounts compared to UC subjects at weeks 4 (26%, 1,405±393 steps/d) and 8 (48%, 2,612±284 steps/d). UC subjects accumulated greater stepcounts on rehab compared to non-rehab days, but no changes were found from baseline for daily stepcounts, rehab, or non-rehab days. There was a time effect for responses to social support from friends for all subjects (baseline to week 4) and a time by group effect for decision balance pro-questions by week 4 where PF significantly increased, UC significantly decreased, and both groups where significantly different. Conclusions: The results of this study suggest that a pedometer-driven PA intervention yields significantly greater stepcounts compared to time-based PA recommendations among maintenance CR patients. / School of Physical Education, Sport, and Exercise Science

Physical inactivity is a significant health concern for individuals in the United States, and is especially an issue for those with a history of coronary artery disease. Increased physical activity is encouraged for those who are participants in Phase III cardiac rehabilitation to promote a healthy lifestyle after a cardiac event. The purpose of the study was to assess and characterize the physical activity levels of Phase III cardiac patients. Other objectives of this study were to compare various forms of physical activity assessment and compare the activity levels of the cardiac rehabilitation participants with other populations. Comparisons of three physical activity devices were analyzed as well as activity levels on rehab and non-rehab days. Those who participated in home exercise vs. those who did not do home exercise were compared as well as those who were retired vs. those who were employed. Subject inclusion criteria included Phase III cardiac patients who were 40-69 years of age and who attended rehab a minimum of two days per week. The subjects were required to wear a pedometer and accelerometer for at least 12 days and complete a questionnaire following the trial. The mean ± S. D. for age, height, weight and BMI of the subjects was 59.4±8.2 years, 69.1±3.1 inches, 200.9±41.8 lbs., and 29.4±4.8 kg/m2 respectively. The Lifecorder, ActiGraph and International Physical Activity Questionnaire (IPAQ) were used to measure physical activity levels of the Phase III cardiac patients. The IPAQ did not correlate well with the Lifecorder or ActiGraph in assessing physical activity in Phase III cardiac patients (R=0.251, P=0.226-ActiGraph and R=0.280, P=0.175-Lifecorder), however, the Lifecorder and the ActiGraph had a significant correlation coefficient with one another (R=0.83, P<0.001). Rehab vs. non-rehab day data as well as rehab session and non-rehab session physical activity levels were compared among the subjects. On a rehab day, subjects took 9,770±3132 steps/day, which was significantly higher than what they took on a non-rehab day, 5,404±2843 steps/day. Those who did not exercise at home accumulated on average 8,194±2912 steps/day on a rehab day, while on a non-rehab day they accumulated 3,475±1579 steps/day (P<0.001). Those who did exercise at home, took 10,883±2856 steps/day on a rehab day, while on a non rehab day they took 6,767±2768 steps/day (P<0.001). Those who were employed were more active than those who were retired. In conclusion, Phase III cardiac rehabilitation is an effective way to increase physical activity levels of those with a history of coronary artery disease. All participants in Phase III cardiac rehabilitation should be encouraged to come into the center-based facility at least 4-5 days per week or implement a home exercise program into their weekly regimen. / School of Physical Education, Sport, and Exercise Science

Clinically, the modified Bruce protocol is widely used to predict functional capacity in cardiac patients. However, it has been suggested that cardiac patients have lower oxygen uptakes for standard workloads. In order to study this, we measured oxygen uptake (V02) and venous bloodV02 derived from lactic acid concentration during a modified Bruce treadmill protocol in 12 pest myocardial infarction (MI) and 12 normal males. During three stages of the protocol mean oxygen uptake was significantly lower (1.42 - 6.2 ml/kg.min; p < .001) for the pest MI than the normal males.However, venous blood lactic acid concentrations were not different at these stages. The MI patients' measured V02 for three stages of the protocol ranged from 1.8 - 7.3 ml/kg.min lower than the Bruce predictions for cardiacs. In addition, measured V02 (max) for cardiac patients were from 3.68 to 11.15 ml/kg.min lower than the predicted the normal subjects. These data suggest myocardial damage may slow oxygen kinetics and results in lower actual V02during treadmill testing. However, blood lactic acid concentrations failed to demonstrate an anaerobic compensation for the lower V02 in pest MI patients.

The present study investigated the extent to which right and left hemisphere stroke patients, within an acute care rehabilitation unit, differ in neuropsychological symptomatology as reported on a self-report instrument.The subjects were 90 patients admitted to an acute care rehabilitation unit within a midwestern hospital. Two groups of 30 were obtained on the basis of stroke location, either right or left hemisphere. In addition, a group of 30 orthopedic patients were selected to serve as a comparison group.Data was collected using the Neuropsychological Symptom Inventory (Rattan, Dean & Rattan, 1989). A discriminant analysis revealed two discriminant functions which were used to classify group membership. Slightly more than 86% of both left hemisphere stroke patients and orthopedic patients were correctly classified. However, only 46% of right hemisphere stroke patients were accurately predicted. The results clearly support the ability to differentiate the groups and suggest a homogeneous character of the left hemisphere stroke and orthopedic groups. The right hemisphere group appears heterogeneous in make-up. Further statistical analysis revealed no significant difference (a<.05) between stroke groups when examining a factor related to emotional/depression symptoms. However, when stroke patients were compared to orthopedic patients on this factor, a high degree of significance was revealed (p<.001).These results suggest that right hemisphere patients cannot be treated as if they make up a single disorder group within the rehabilitation setting. The use of a self-report measure may prove beneficial with this group is assessing the level of neuropsychological impairment and to make modifications in treatment planning. Additionally, the existence of depression within the stroke group suggest that rehabilitation should focus more on these reactions within the first few weeks post-stroke. / Department of Educational Psychology

The purpose of this study was to investigate the relationship between the Affective Facial Recognition Test (AFRT) and Facial Recognition Test (FRT) with a group of right and left hemisphere CVA patients and controls. In addition, the differences in abilities of right and left hemisphere CVA patients and controls to perform on these two tests was explored. The four null hypotheses were: (a) There will be no significant differences between right and left hemisphere damaged patients and controls on the AFRT, (b) There will be no significant differences between right and left hemisphere damaged patients and controls on the FRT, (c) There will be no significant relationship between the AFRT and FRT with right hemisphere damaged patients, and (d) There will be no significant relationship between the AFRT and FRT with left hemisphere damaged patients. Hypotheses one and two were statistically analyzed by using a One-Way Analysis of Variance and three and four by a Pearson Product Moment Correlation.Experimental group subjects were 16 right and 16 left hemisphere CVA volunteer patients obtained from Community Hospital, Indianapolis, Indiana. The control group was composed of 16 non-neurologically impaired subjects from the Muncie, Indiana area. All subjects were equated with respects to age, education, and post-injury. The subjects were randomly administered the AFRT, FRT, and Comprehension subtest of the WAIS-R. The Comprehension subtest was used as a screening device to insure that the patients understood what was expected of them during the testing. The testing, data analysis, and interpretation was completed between May, 1982 and February, 1984.All four hypotheses were rejected. Right and left hemisphere CVA patients and controls significantly differed in performance on the AFRT and FRT (r<.01). In short, right and left hemisphere CVA's were significantly impaired on the AFRT and FRT when compared with the controls. However, both experimental groups exhibited equal impairment on the two tests. This suggests that neither affective facial recognition nor facial recognition is hemispherically lateralized. Also, a higher relationship (r=.79) was found between the AFRT and FRT with right hemisphere patients as opposed to left (r=.65). This appears to indicate that both tests are measuring similar neurological functions and that the inability to match unfamiliar faces and affective faces may not be two separate disorders.

No description available.

This study examines the validity of using a combination of two psychometric measures, an emotional adjustment measure, and functional assessment measures to predict vocational outcome in a traumatically brain injured population. Patients included 33 males and 11 females, with an average age of 32.3 years, and a stable work history over the past three years prior to injury. All had sustained a traumatic brain injury in the 12 months prior to initial testing, with a mean of 3.8 months since injury. Levels of severity of injury included 24 patients with severe injury, 12 patients with moderate injury, and 8 patients with mild injury. Patients completed the Logical Memory subtest (LM) of the Wechsler Memory Scale-Revised, Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), and Personal Capacities Questionnaire (PCQ). A clinician working closely with the patient also completed the Functional Assessment Inventory (FAI) and the Behavior Checklist (BC) at the time of initial testing. Follow-up testing on available patients (n=16) was completed approximately six months after initial testing. Comparison of the functional assessment measures demonstrated that patients exhibited a decreased awareness of functional limitations relative to clinician's ratings, but identified an increased number of personal strengths. The present study demonstrates the first comparison of FAI and PCQ ratings in a TBI population, as well as the first available field research using the PCQ. Results also indicated that the only significant predictor on earned income after six months was the overall functional limitations score on the PCQ. The only significant difference in patients' test performance at six months with scores at initial testing was seen on the PASAT, which suggested that patients had a significant improvement in their speed of information processing after six months. In addition, comparison of patients from Canadian and American rehabilitation agencies, respectively, revealed no significant differences between patients at either initial testing or at follow-up. / Graduate

M.A. / With the advances achieved in medical technology in recent years, society is increasingly faced with the issue of determining how fit individuals are for reintegration in society following the event of traumatic brain injury. Together with Neurology and it's diagnostic capabilities, many other disciplines such as Neuropsychology, Physiotherapy and Occupational Therapy, to name but a few, have placed strong emphasis on the rehabilitation of individuals with brain damage, with a view to reintegrate them into society. Besides the physical rehabilitation which aims at normalizing the individual's physical health, issues such as psychological ,cognitive and social functioning have been the focus of a great body of research in recent years. Whereas in the past the prognosis for many such patients in respect of returning to a normal life style were discouraging, health workers are now more optimistic in most cases regarding the individuals' probability to achieve a higher level of functioning after recovery. In this context, the individuals' ability to function in society, their ability to be integrated into the family and working environment and competence to be active and valued members of society have thus become the new aims which the therapeutic team together with the patient strive to achieve. With this in mind, rehabilitation teams now place greater emphasis and effort on optimizing recovery in the areas of cognitive and emotional competence. Amongst these issues, the individuals' competence to make moral judgements and socially adequate decisions in everyday living is of the utmost importance. This impacts on their ability to abide by social rules and norms which will determine their competence and desirability as active members in the family, social and working environments. This is the main focus of the present study. The issue of moral judgement and behaviour is central to this discussion, and a delineation of what defines morality and moral judgement is mandatory. Contributions to this analysis were found in the writings of the various authors and schools of thought presented here, and each of them has dealt with the theme of morality, moral behaviour and judgement from a different theoretical perspective. Theorists such as Lawrence Kohlberg made a major contribution to the understanding of the development of moral judgement through his stage theory, which forms one of the cornerstones of the present study. The site and the severity of the brain injury is paramount to the prognosis for rehabilitation. The frontal lobes have been described as the structures responsible for the widest range of symptoms and seen as the seat of intellect, responsible for deviations in moral and emotional functioning. An overview of the frontal lobes and associated cognitive functions as well as behaviors observed as a result of injury to these structures is presented. The existential-phenomenological system of inquiry has been described by its proponents as the most adequate to investigate phenomena relating to human behaviour, when an understanding of the subjective experience of the individuals involved is desired. For this reason this methodology is used in the present study to facilitate a qualitative analysis of the experience of brain injury particularly in respect of possible alterations in moral judgement and behaviour following the accident. The present investigation is based on interviews with three subjects and their primary caretakers, who answered questions regarding moral dilemmas. These dilemmas aim at tapping the individual's underlying reasoning processes when faced with the decision of what is right and wrong. The analysis and integration of the data obtained through these interviews reveals a complex cluster of alterations in thought and behaviour, much in line with those expected from patients suffering traumatic injury of the frontal lobes. Although different behaviours were revealed by each participant in this study, they were generally in line with the alterations described in the literature resulting from injury to the described brain areas. The value of this study lies in projecting a clearer picture of the experience of brain injury from the point of view of the victims as well as the close family members. Furthermore, analysis of data obtained in this investigation highlights certain typical behaviors and responses observed in individuals with such brain injuries, as described in the literature presented here.

M.Cur. (Intensive General Nursing) / The rehabilitation of the coronary artery bypass patient should be a continuation of the contact which exists during the hospitalisation phase, with specific reference to the pre-dismissal phase. As a member of the health team, the nurse makes the most important inputs during this phase because she is the one who is in constant contact with the patient and his family. The purpose of this study is to determine, by means of set criteria and within a nursing perspective, the contributions that are made by various support groups to the rehabilitation of persons who have undergone coronary artery bypass surgery.

This study evaluates the outcomes of a hospital-based cardiac rehabilitation program designed to deliver the first phase of cardiac rehabilitation services at home. The program was established in a community hospital in 1985, operating under the administration of the hospital's Medical Day Centre. Patients suffering from acute myocardial infarction (MI) are referred to the program by their physician and receive services from a cardiac nurse specialist immediately upon discharge. The services continue for a period of 6 weeks. The outcomes of importance in the study are the effects of the program on hospital services in the initial 10 month period and on patient's health related behaviour 3 months post infarction. Results of the study indicate that program goals were achieved during the initial 10 months of the study. Physicians referred 92% of the eligible patients and the average length of stay (ALOS) in hospital was satisfactorily reduced. For patients with uncomplicated MI the ALOS was 8.6 days by the tenth month. At 3 month follow up, patients reported significant improvements over their pre infarction health related behaviour. There were significant increases in the frequency of light exercise (p<-0005), in the regular use of low fat dairy products (p=.0003) and in the practice of restricting calories (p=.003) while significant decreases were reported in the frequency of consuming fried foods (p<.0005), salted foods (p<.0005) and rich foods (p<.005) and in the regular use of table salt (p=.00003). Smoking cessation was reported by 50% of the smokers at follow up. Patients reported a high level of satisfaction with the program, describing the service as well timed, informative, practical and valuable in restoring their self confidence. While these results were satisfactory with regards to the program goals, the evaluation was based on a single group design and further investigation is desirable with comparisons between hospitals and between patients with and without exposure to the program. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate