Gaze stabilization test (GST) and dynamic visual acuity (DVA) test are functional measures of the vestibulo-ocular reflex which helps to maintain clear vision during head movement. The purposes of this dissertation were threefold; first the reliability of GST and DVA test were examined. Twenty-nine patients with vestibular disease were tested repeatedly using the computerized InVision™ test. Results showed that the reliability of the tests were fair to poor with the DVA reliability better than the GST and the within-session reliability better than between-session reliability. In the second Aim, the goal was to obtain better understanding of the effect of optotype (the letter E) parameters on subjects' performance. The performance of twenty-one healthy young subjects on the GST was examined over a range of optotype sizes and presentation times. Results showed that the optotype parameters had a significant effect on subjects' performance with only one combination in which most healthy subjects were able to accomplish fast head velocities while being able to identify the optotype correctly. An optotype that is 0.30 logMAR above a subject's static vision and presented for 40 msec longer than minimum presentation time is recommended for future testing. Lastly, the preferred combination from the second Aim was used to examine the performance of twenty-two young patients following concussion and compare it with the healthy subjects from Aim 2. Correlations between patients' performance on the GST and their scores on tests commonly used following concussion were also examined. Results showed no significant differences between the performance of patients and that of healthy subjects on the GST. Also, there were no significant correlations between the GST and other measures used following concussion. Results show that the protocol used for the GST needed refinement. Special consideration is to be given to the optotype parameters used since these were found to significantly influence performance. The lack of significant differences between patients following concussion and healthy subjects could be due to the inclusion of all patients following concussion without objective evidence of vestibular involvement. Future studies should use specific optotype parameters and include patients following concussion with evidence of vestibular dysfunction.

The need for assistive technology (AT) extends far outside of the countries where users have the financial capacity to buy them, or there is a social welfare infrastructure to subsidize their purchase. In developing countries, where both technology and financial resources are scarce, AT users face tremendous challenges to find high-quality devices that are affordable. This scenario is in part due to organizations who transfer sub-standard AT to these countries by taking a 'something is better than nothing approach' to a clinically and technologically challenging problem. The goal of this work is to develop and demonstrate AT design and technology transfer strategies that take into consideration the clinical and technological needs of the intended user population. Although other projects have and do take these important user-centered factors into consideration, this work represents the first comprehensive attempt from an academic perspective, where hypotheses are proposed and tested, and design goals are described and evaluated with respect to the final product. The main focus of this work is on mobility devices (wheelchairs, specifically) although many of the protocols and techniques could be extended to address AT design and technology transfer to developing countries in general. The first part of this dissertation (Chapters 1 & 2) focuses on the background literature, and proposes a model describing the important factors influencing the success or failure of a wheelchair technology transfer project. The second part of this dissertation provides a case study in the development of an electric powered wheelchair for users in India. First, an analysis of a commercially available low-cost powered wheelchairs were evaluated (Chapter 3). Second, a study to assess the needs of users in India was performed using a modified ethnographic approach (Chapter 4). Third, the design and evaluation of a novel low-cost electric powered wheelchair for Indian users is described (Chapter 5). The final chapter (Chapter 6) discusses the implication of this work and suggests future directions. The entire drawing-set for the second generation prototype developed here is also included, allowing others to build upon the approach and the design developed here.

The use of mobility assistive (MAT) devices has been pointed out as important factors to improve impaired mobility. The overall purpose of the study was to investigate the benefits of a new MAT device among people with multiple sclerosis (MS). This dissertation was based on three studies that investigated characteristics of MAT devices mostly used by adults with MS and the compliance of scooters, popular MAT devices among this population within three studies. The first study was a systematic literature review of research related to the use of mobility assistive technology (MAT) devices among persons with multiple sclerosis (MS). Results of this systematic review showed that there are limited numbers of articles with higher levels of evidence were found in regards to use of MAT benefits specifically for adults with MS. The second study investigated the impact of MAT devices on quality of life, community participation and satisfaction with MAT devices of this population. We collected information of participants who came to two specialized seating and mobility clinics in Western Pennsylvania and MS support groups. Overall, participants reported an increase in physical independence among participants who received new MAT devices. Satisfaction with MAT device at follow up increased particularly among participants who transitioned from non-wheeled to wheeled MAT devices. The third study investigated compliance of 4 scooter models with ANSI/RESNA standards. Our results suggest that scooters currently available may not meet ANSI/RESNA standards. These results have serious implications to the users who rely on these devices to conduct their daily activities. Furthermore, these results indicate that the regulatory framework to ensure these devices are safe may need to be revised.

Rationale: Many community-dwelling stroke survivors receive care from their family, often daughters. However, we lack in-depth information on the caregiver/care-recipient relationship and its impact on adult daughter caregivers (ADCs). Objective: To systematically review the caregiving literature and qualitatively explore the pre-and post-stroke parent-to-child relationship and its association with ADCs’ well being. Method: A qualitative descriptive methodology used in-depth interviews of 23 ADCs. Analyses generated themes. Findings: Four themes were revealed: 1) The pre-stroke ADC-to-parent relationship is associated with the decision to take on the caregiving role; 2) Changes in the parent-to-child relationship occur as a result of providing care; 3) Changes to an ADC’s relationships with others arises from providing care to a parent and 4) Changes to caregiver lifestyle, outlook and physical and emotional well being arise from caregiving. Conclusion: There is a need for interventions that focus on role strains and issues related to relationship loss.

Rationale: Many community-dwelling stroke survivors receive care from their family, often daughters. However, we lack in-depth information on the caregiver/care-recipient relationship and its impact on adult daughter caregivers (ADCs). Objective: To systematically review the caregiving literature and qualitatively explore the pre-and post-stroke parent-to-child relationship and its association with ADCs’ well being. Method: A qualitative descriptive methodology used in-depth interviews of 23 ADCs. Analyses generated themes. Findings: Four themes were revealed: 1) The pre-stroke ADC-to-parent relationship is associated with the decision to take on the caregiving role; 2) Changes in the parent-to-child relationship occur as a result of providing care; 3) Changes to an ADC’s relationships with others arises from providing care to a parent and 4) Changes to caregiver lifestyle, outlook and physical and emotional well being arise from caregiving. Conclusion: There is a need for interventions that focus on role strains and issues related to relationship loss.

The ability to safely and efficiently negotiate stairs is an essential skill for independent ambulation. To date, basic research to identify biomechanical and physical costs is limited in older adults. In persons with stroke, this aspect of mobility is virtually unexplored. The main objective of this thesis was to investigate biomechanical alterations during stair negotiation and to evaluate the physical costs of the task in older adults and persons with stroke. This was approached by conducting four studies. The first study identified age-related alterations in joint kinetics during stair negotiation. The results showed age-related differences in moment magnitudes, an exaggerated net support moment and sustained abductor moments through stance. To gain insight into these adaptive changes with respect to mechanical efficiency, the second study evaluated age-related changes in mechanical energy transfers during stair negotiation. During ascent, older adults achieve similar efficiencies as young adults by slowing their cadence. During descent, age-related differences in mechanical energy expenditures and related variances in mechanical energy compensation coefficients reflect a loss in mechanical efficiency. The impact was likely the provision of enhanced extensor support and stability. The results also highlight a functional role for concentric energy expenditures during descent. The third study provided a detailed biomechanical description of stair negotiation in people with stroke, revealing important differences in how stroke survivors manage stairs and how handrail use modifies the magnitudes of lower limb joint moments. The fourth study evaluated the strength and aerobic requirement of stair ambulation in persons with stroke. The findings reveal increased costs of the task, primarily due to reduced neuromuscular and aerobic capacities and serve to identify factors that may be limiting during stair negotiation. This thesis provides new information regarding movement control in older adults during stair negotiation, providing a normative benchmark of age-related alterations in movement patterns. In persons with stroke, this work is the first to quantify the biomechanical patterns and physical requirements of stair negotiation. Future work may extend these findings to explore mobility challenges in persons with greater levels of impairment as well as guide the development of targeted and task oriented rehabilitation programs. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2011-08-25 09:24:26.106

<p>This thesis summarizes the findings of two studies, one qualitative and one quantitative, that examined the participation of adults with class III obesity in occupations of everyday living which included work, self-care, recreation and rest. The results of this research form the basis of the three manuscripts included in this thesis.</p> <p>The purpose of the first study was to describe the experience of living with obesity in the context of participation in daily activities and to identify factors that constrain or facilitate participation. Using a descriptive, phenomenological approach, in-depth, semi-structured interviews were conducted with 10 adults who were enrolled in an obesity treatment program. This analysis revealed themes that underscored the tensions, barriers and coping strategies across and within occupations of everyday living. The quality and diversity of occupation was influenced by several barriers within their environment such as inaccessible physical spaces and negative attitudes towards persons with obesity. Participants described their lives as being "on-hold" until weight was lost. Findings from this study were used to develop a larger, cross sectional survey.</p> <p>The purpose of the cross sectional survey (study number 2) was to describe how adults with class III obesity spend their daily time and to identify factors that predict participation in the occupations of everyday living. An analysis of data collected (n= 128) using the Occupational Questionnaire revealed that the distribution of time spent across activities classified as work, daily living, recreation and rest was similar to the time use of adults with chronic health conditions. A multiple regression analysis (n=140) resulted in a model in which factors including social support and disability status explained 35% of the variance in satisfaction with participation.</p> <p>Results of these studies contributed to a better understanding of the daily experience of participation in the occupations of everyday living for adults with class III obesity and the factors that best predict satisfaction with participation.</p> / Thesis / Doctor of Philosophy (PhD)

The term ‘disability’ is laden with medical origins and medical meanings, which contribute to exclusion and oppression for persons labeled as ‘disabled’. Moreover, these processes are amplified by constructing disability as an individual burden or personal tragedy. Medicalizing disability keeps it a personal matter, a personal problem that needs to be treated, rather than addressing the social processes that actually restrict or constrict the disabled person’s life. Rehabilitation Science and my lived experience of disability and walking serve as contexts that assist me as I explore how my subjectivity as a disabled woman and clinician helps me understand the theoretical tensions of five key themes: independence, power, client-centred practice, ableism, and the social model of disability in relation to disability and rehabilitation. These themes offer me a way to analyze my experiences, and how I have come to access and engage with Disability Studies literature in order to deepen my understanding of the critiques on disability and rehabilitation. As an insider, my research explores three decades of personal narrative. Through critical reflexivity as part of autoethnography, I work to increase my own awareness and that of my readers on the tension and complexities with respect to disability and rehabilitation. / Dissertation / Doctor of Philosophy (PhD)

BACKGROUND: The mandate to provide inclusive education in Canadian schools means that Speech-Language Pathologists (SLPs) need to be well-versed in frameworks such as Universal Design for Learning (UDL) that support learning among students with diverse backgrounds and abilities. To be responsive, professional graduate programs need resources that support teaching SLP students about UDL. PURPOSE: 1) To use an instructional design model and Knowledge Translation (KT) theory to develop educational resources about UDL for SLP graduate students; and 2) to assess feasibility of the resources and SLP students’ perceived and actual UDL knowledge change after resource implementation. METHODS: First, educational resources about UDL were created for SLP students using a process in which the first three phases of the Analysis, Design, Development, Implementation, Evaluation (ADDIE) instructional design model were combined with the Diffusion of Innovations (DOI) KT theory and supported by engagement of key SLP stakeholders. Stakeholder feedback about their involvement in the resource development process was assessed through a focus group and analyzed using conventional content analysis. Next, the last two phases of the ADDIE model were conducted in which the developed resources were implemented and evaluated with 19 SLP students over a three-hour session; resource feasibility and UDL knowledge were measured before and after the session using anonymous, web-based questionnaires. RESULTS: The novel process for developing resources was deemed suitable for creating high-quality theory-informed resources tailored to SLP students. SLP students perceived the resources to be practical and acceptable. There was a statistically significant improvement in students’ perceived UDL knowledge as well as improvements in actual UDL knowledge. CONCLUSION: Health educators could consider the described methodology when developing content-specific resources for health professional students. This thesis introduces a new set of resources that could be used to address an important gap in SLP training. / Thesis / Master of Science Rehabilitation Science (MSc) / Inclusive education in which students with diverse abilities learn together is an expectation within Canadian schools. People who work in schools, like Speech-Language Pathologists (SLPs), need to know about frameworks such as Universal Design for Learning (UDL) that identify specific strategies for supporting inclusive education. However, many SLPs do not know about UDL or how to apply this framework when they work with teachers. In this thesis, I used a new resource development process involving a rigorous resource design method with a theory that helps people use new ideas, to make educational resources about UDL for SLP graduate students. Next, I implemented and evaluated the resources with 19 SLP students at McMaster University. Students felt the resources were suitable and taught them new information about UDL. This thesis provides new teaching resources for SLP students to increase their knowledge about UDL and better prepare them for working in schools.