These studies developed methods for quantifying balance control while humans exert manual forces. The global purpose was to assess the situations in which elderly individuals commonly fall. These observations were used to recommend environmental modifications that might decrease the incidence of falling in the elderly. This was a departure from traditional tests of balance in which the subject stands in place with feet fixed; in the present studies, subjects performed various manual operations and walked while making light fingertip contact with a handrail. Balance was assessed on the basis of manual forces, body accelerations, alignment of hand forces with respect to the feet, moments of hand forces about the feet, and ‘body center of pressure.’ The latter measure was analogous to the traditional calculation of center of pressure on the ground, except that the body was subjected to the additional reaction forces at the hands.

The aim of this dissertation was to explore alterations in human skeletal muscle during a controlled period of immobilization and following spinal cord injury (SCI). Study I examined the effects of an imposed period of immobilization of the adductor pollicis (AP) muscle on muscle function and volume in young (18-25 years) and aged (60-75 years) men. Muscle strength and volume of the AP was assessed before and after immobilization. Results from Study I show that although the older and younger adults had disparate losses in muscle volume they experienced similar losses in muscle strength. These results confirm that even short periods of inactivity promote more rapid losses in muscle volume in older adults, while the ability to generate force is maintained. Study II and Study III of this dissertation explored the molecular alterations in human skeletal muscle in response to immobilization or SCI. Muscle biopsies were analyzed at both the transcriptional (microarray analysis, quantitative Real-Time Polymerase Chain Reaction (qRT-PCR)) and translational (Western blotting, Immunohistochemistry (IHC)) level. In Study II, the knee joint of five young men (aged 18-25 years) was immobilized, and muscle biopsies were performed before and after 48h of leg immobilization. Immobilization resulted in increased expression of genes involved in the ubiquitin proteasome pathway and metallothionein function, but no change in respective protein products. However, results of Study II also showed a decrease in gene expression and protein products for the collagens, which are involved in extracellular matrix (ECM) integrity, indicating that disruption to the ECM is an initial step in the muscle atrophy program following immobilization. In Study III, analysis of muscle biopsies taken two and five days post-SCI, compared to healthy controls, showed increased gene expression for genes that encode components of the ubiquitin proteasome pathway, metallothioneins, and secretory leukocyte protease inhibitors. Western blotting and IHC showed that protein products for components of the proteolytic core and the metallothioneins increased by five days post-SCI, and protein products were localized to the ECM. These results indicate that components of the ECM are initial targets of proteolytic activity within the first days following SCI.

Objectives: To evaluate the effectiveness of cognitive rehabilitation therapy with patients with schizophrenia within a forensic population. The intervention aimed to improve domains of cognitive functioning which have been found to be impaired as a result of schizophrenia. Forensic patients with schizophrenia have been found to have greater impairments in cognitive functioning relative to non-violent patients. Therefore interventions which target these deficits are important in rehabilitation interventions. Design: A within subject repeated design was used. A control measure was also implemented which involved patients being used as their own control. Method: 17 participants successfully completed the cognitive rehabilitation intervention. Initially 23 participants were recruited. Participants received approximately five hours of the computer-assisted cognitive remediation administered over seven weekly sessions. Outcome measures were cognitive assessments measuring executive functioning, attention, verbal learning and memory, perceptual organisation and visual memory. Outcome measures were administered pre-intervention, during treatment, post treatment and at three months follow up. A control assessment was also administered prior to the commencement of the intervention. Results: Post treatment measures on attention, perceptual organisation, visual memory and aspects of executive functioning were found to be significantly improved in comparison to pre intervention and control assessments. At 3 month follow up these improvements in cognitive functioning were found to be sustained. Conclusion: The pilot study indicated that cognitive rehabilitations are effective in improving cognitive functioning within forensic populations with schizophrenia. These results have the potential to improve functional outcomes and recovery, which could indirectly improve symptoms and risk of future violence. Further research is required in this area to provide additional evidence for this intervention to be available to forensic patients with schizophrenia.

Recorded at Sunny Hill Centre for Children on Apr. 19, 2007

The factors influencing the retention of physical therapy college faculty had not been previously substantiated. In this study investigating faculty retention, all 36 full-time faculty from the four accredited, entry-level physical therapy programs in a large southern state, received a questionnaire. Twenty-eight (78%) returned the completed questionnaire. In addition, interviews were conducted with eight consenting faculty, two from each of the four universities. Although mentors are considered by physical therapy faculty to be very valuable, mentorship alone did not significantly affect physical therapy faculty retention. In addition, no significant differences were noted between mentored and non-mentored faculty with regard to gender, rank, tenure, salary, career selection, prospects for future success, and job satisfaction. In addition, gender did not significantly influence retention, salary, tenure, rank, prospects for future success, career planning, feelings about job change or retention in present job. In this study a slightly higher percentage of women versus men were mentored. The majority of women and all men had a mentor of the same gender. Unlike women in male dominated professions, women in physical therapy faculty positions found other women and men willing to act as their mentors. Women also tended to remain in the mentoring relationship for more years than men. Mentored faculty, particularly women, had also taken on the role of mentor, thus perpetuating the mentor relationship legacy. Both women and men experienced relatively few problems as compared with the many benefits of the mentor relationship. There appeared to be a variety of factors influencing faculty retention. The questionnaire results revealed rank and tenure to influence faculty retention positively. Within the interviews, faculty most frequently mentioned other "faculty", as a positive feature attracting them to and retaining them within their institution. Salary, although not a significant finding in the survey, was mentioned several times throughout the interviews. It appeared that when salaries reach a critically low level, one lower than or approximating the salary of new graduates, faculty reconsider their options for clinical rather than academic jobs. The institution studied that had the highest retention also had the greatest percentage of tenured faculty and the second highest salary.

The goal of this dissertation was to identify and characterize underlying mechanisms of exercise-induced muscle damage (EIMD) and muscle adaptation to damage. Study I examined contributions of central and peripheral factors to EIMD. Forty-six subjects performed voluntary and stimulated contractions before and immediately following eccentric exercise of the elbow flexors. Subjects demonstrating greater strength loss (a hallmark of EIMD) after eccentric exercise also had greater impairment of peripheral function, but similar central function compared with lower strength loss subjects, suggesting that the mechanism(s) driving variation in strength loss are localized mainly within the periphery. Study II further focused on peripheral factors, specifically molecular changes in gene expression within muscle tissue following eccentric exercise, to determine underlying molecular mechanisms of damage development. Three subjects performed an exercise in which one leg underwent concentric contractions, and the other leg performed both eccentric and concentric actions. Dependent variables included strength loss, soreness and serum creatine kinase activity. Muscle biopsy samples were taken 4-8h post-exercise. Microarray analysis of these samples identified upregulation of genes involved in inflammation, apoptosis (programmed cell death), structure and transcriptional regulation. These results provided the first global gene expression pattern of human muscle after eccentric exercise. EIMD is attenuated naturally via the repeated bout effect, where an initial bout of exercise confers a protective effect on muscle that results in less damage induced by a second bout of exercise. Study III aimed to identify mechanisms driving this adaptation. Seven subjects performed two bouts of eccentric exercise of the leg spaced 4wk apart. Muscle strength and soreness were evaluated and biopsies were collected at 6h post-exercise. Muscle samples were tested for expression of a subset of inflammatory genes identified in Study II. Study III showed upregulation of monocyte chemoattractant protein-1 and the transcription factors CEBPD and ZFP36 following the repeated bout. Monocyte chemoattractant protein 1 (MCP-1) was co-localized to macrophages and satellite cells, which are vital to muscle regeneration. These data suggest that specific alterations in the inflammation response may drive the repeated bout effect, possibly by enhancing communication between macrophages and satellite cells, which may strengthen muscle regeneration following EIMD.

No description available.

Post-stroke sexual difficulties are common but sexuality is an area frequently neglected within stroke rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. This was hoped to improve understanding of why current guidelines around addressing post-stroke sexual issues are not followed, and what would support professionals to meet patients’ needs. Ten healthcare professionals working within stroke rehabilitation were interviewed, covering a range of disciplines and settings. The data was analysed using grounded theory methodology. Fourteen major categories were co-constructed from participants’ data and a theoretical model was developed. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with the sexual concerns of their patients. Concerns were usually addressed through the provision of information and supportive conversation with a professional. Professionals’ own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engaging with sexual concerns. These barriers included environmental factors relating to the context of stroke rehabilitation, professionals’ perception of lacking abilities and unhelpful attitudes towards patients and sexuality. Positive and inclusive attitudes towards sexuality and professional roles and building a strong therapeutic relationship facilitated professionals taking action. The findings are considered in relation to existing guidelines and research, and the clinical implications for rehabilitation and staff training are discussed.

Everyday occupations have mainly been studied in the fields of occupational therapy and occupational science within a Western context. Research has mostly focused on individual occupations of people with disabilities, and findings were mostly interpreted within Eurocentric and human-centred perspectives that misrepresented marginalised communities and their daily lives. Aiming to reduce some of this gap in knowledge, I set out to explore everyday activities of olive farmers in the occupied Palestinian territories (oPt). My ‘liminal’ positionality of being a Palestinian living and working in the UK enabled a bridging between Palestinians’ ways of life in the Global South and occupational science as a Global North perspective. I posed two research questions: How do the structures, policies and practices of Israeli settler colonialism and its military occupation influence the daily activities of olive growing communities in the oPt? What are the means that communities adopt to enable the daily occupations of olive farming to continue? I wished to study the motivations and principles for the activity of olive growing which were used as active responses – or resistance – to occupational injustices caused by settler colonialism. I designed a study that adopted de-colonial ethnographic methods. Field trips were carried out throughout the olive growing cycle, during which 11 in-depth interviews were conducted with – and observations made of – participant families and individual participants. An iterative (inductive and deductive) thematic analysis and an ‘intercultural translation’ (Santos, 2014) resulted in identification of themes, which were analysed in relation to Wilcock’s ‘occupational determinants of health’ (2006). Sutra expressed the Doing for Well-being principle of olive growing, A’wna was identified as the collaborative aspect of the activity, or the Doing for Belonging to land and people, and Sumud – as a third principle of action for olive growing – means that olive farmers do this activity for Belonging and Becoming, or as a resistive daily act. Sutra-A’wna-Sumud were collectively conceptualised as Everyday-Forms-of-Resistance (to occupational apartheid), were found to extend occupational sciences’ notions of Doing-Being-Becoming-Belonging, and illustrated communal Palestinian ways of knowing and resisting. Sutra-A’wna-Sumud demonstrated a set of means of action and interpretation that move beyond the individual as the main area of concern, and perceive human communities as a continuation, and in mutual relation to, their environment. This study provides insights, learned from a Global South group, on specific manifestations of occupational apartheid, a unique collective occupation (olive growing) and an occupational consciousness (Sutra-A’wna-Sumud/ Everyday-Forms-of-Resistance) that was employed to counter occupational apartheid. This is hoped to widen occupational science’s and occupational therapy’s understanding of people, their environments and occupations, which will be useful in other fields of study concerned with humans, their daily activities and their well-being.

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance, and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physical therapy promotes recovery; however, the benefit of earlier therapy is unclear. Hypothesis: Earlier vestibular therapy for young athletes with SRC is associated with earlier return to play (RTP), return to learn (RTL), and symptom resolution. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients aged 5 to 23 years with SRC who initiated vestibular rehabilitation therapy (VRT) from January 2019 to December 2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤30 days postinjury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots, and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients (10 early, 13 late) aged 16.14 ± 2.98 years and 43.5% were male patients. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110 days [61.3, 150.8] vs 31 days [22.5, 74.5], P = 0.03) and to achieve symptom resolution (121.5 days [71, 222.8] vs 54 days [27, 91], P = 0.02), but not to RTL (12 days [3.5, 26.5] vs 17.5 days [8, 20.75], P = 0.09). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution (P = 0.01). Conclusion: This pilot study suggests that initiating VRT within the first 30 days after SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT should be pursued to further improve recovery time. Clinical Relevance: Clinicians should screen for vestibular dysfunction and consider modifying follow-up schedules after SRC to initiate VRT within a month of injury for improved outcomes.