Abstract not available.

Gait speed is an ideal measure of locomotor recovery following stroke but its responsiveness and clinical terminants have received little attention. The main objectives of this prospective study were to identify the most responsive clinical measure of gait speed, and to identify predictors of gait speed recovery in the acute phase post-stroke. Fifty clients were evaluated on four tests of gait speed, and other measures of disability and impairment during the first and fifth week following a first-time stroke. Responsiveness was estimated using standardized response mean, and four other indices. Multiple linear regression was used to identify significant predictors of gait speed measured at follow-up. Walking 5 metres at a comfortable pace was identified as the most responsive method of measuring gait speed. Functional mobility and initial gait speed were significant predictors of gait speed recovery. Task-specific training may be warranted to improve this outcome.

Despite its importance in activities of daily living, little research has been done on the recovery of upper extremity (UE) function in acute stroke. The objectives of this prospective study were to quantify the recovery of UE function during the first five weeks post-stroke; to compare the recovery of UE function with the recovery of lower extremity (LE) function; and to identify predictors of recovery of UE function. / Fifty-five first-time stroke patients were evaluated using measures of UE and LE function at the first and fifth week post-stroke. Standardized response means were used to compare the recovery of UE and LE. Multiple linear regression was used to identify predictors of UE function. There was no evidence that the recovery of the UE was different from that of the LE. Measures of UE function at the first week post-stroke were the most important predictors of UE function one month post-stroke.

New treatments such as functional electrical stimulation (FES) have been developed that allow people with spinal cord injury (SCI) the ability to stand and walk. This study investigated the use of FES-assisted gait training for two subjects with incomplete spinal cord injury in a single subject, repeated measures A-B design. Average walking velocity, cadence and stride length were determined while walking with and without FES at baseline and post-treatment evaluations. Changes in parameters were analyzed statistically and explained in biomechanical terms. FES-assisted gait training affected modifications in the gait parameters. One subject, initially a non-reciprocal walker, was able to walk overground at a faster velocity, cadence and longer stride length. Both subjects showed gains in these parameters over time. This study provided positive evidence for the use of FES-assisted gait training for these individuals with incomplete SCI. This may indicate that FES is a potentially useful rehabilitative tool as a gait aid for persons with SCI.

Among spinal-cord-injured (SCI) subjects with an incomplete motor function loss that are able to walk, most have an altered walking pattern and a reduced walking speed. This doctoral project had two main objectives. One was to characterize the gait pattern of SCI subjects and compare it to that of normal subjects walking at the same speed. The other objective was to measure the adaptability of their walking pattern to changes in speed, and to find the factors that are limiting their maximal walking speed. The main gait characteristics in SCI subjects found in the first study were: a longer cycle duration, a greater hip excursion, a flexed knee at foot contact and during stance, and changes in the timing and the amplitude of muscle activity. It was showed that SCI subjects could adapt to different speeds, but that their range of speeds is limited. The hip-knee angle cyclographs showed that SCI subjects' intralimb coordination patterns were altered. In normal subjects, even at low speed, the soleus muscle showed a peak of electromyographic (EMG) activity synchronized with push-off, and this peak of activity increased with speed. SCI subjects showed a lower and a flatter profile than that of normal subjects and a diminution of a peak of activity in the soleus muscles at push-off. Increases in treadmill speed in SCI subjects resulted only in a small increase in the amplitude of soleus EMG activity. This increase was not specific to push-off, but rather spread over most of stance duration. The second article showed that maximal stride frequency was the predominant limiting factor of the maximal treadmill-walking speed in SCI subjects. At all speeds, SCI subjects spent longer time in stance, swing and double support phases. The relative time spent in single support is greater at higher walking speed and the difficulty to reduce double support time is a limiting factor. It was concluded that a better understanding of the factors limiting the maximal speed in SCI subject

Functioning, the most important outcome of stroke interventions, is complex to characterize. Stroke survivors measure functioning compared to what they did in their prestroke lives; hence equating functioning with recovery. To optimize the recovery of functioning, research suggests that rehabilitation interventions should start early post-stroke. To quantify changes in function owing to different interventions, the average value on an index comprised of multiple items related to function is compared or the proportions of people categorized into different functional levels are compared. Currently, there is no agreed upon method of quantifying improvements in functioning and using multiple indices is problematic. This thesis examined combining a method of quantifying behaviours, Rasch analysis that produces measures with interval properties from ordinal observations, with the component of the International Classification of Functioning (ICF), to conceptualize, define, and quantify functioning in a single measure. The ensuing prototype measure was limited in scope. Therefore, using data from a longitudinal prognostic study involving people with acute stroke assessed at three days and followed up at three months, a Functioning measure at three months, the F3m, was developed. The F3m is a valid and reliable measure that amalgamates tests where performance is observed and self-report questionnaires where people rate their difficulties in performing physical activities. The F3m covers all ICF components and can be used to quantify recovery at three months. Interventions to improve early functioning post-stroke must impact favourably on the factors that affect early recovery. The most influential factor related to recovery, to date, has been early functioning. As a measure of such early functioning did not exist, a measure of functioning at three days, the FM, was constructed in a manner similar to the F3m. Univariate and multivariate analyses were then used to identify strong early factors collected 24-72 hours post-stroke, and link the factors to function at 3 months. A seven-variable predictive model of functioning was derived. The most important influential predictor of functioning in the model, the comprehensive FM measure, can now be used to evaluate and develop early interventions to enhance functioning, and to act as a covariate explaining the recovery of functioning.

Background and rationale. Cerebral palsy (CP) is one of the most common disabling disorders of childhood and constitutes a substantial portion of pediatric rehabilitation. This condition demands comprehensive rehabilitation using age-appropriate tasks and activities and encompassing aspects of body function and structure, activity and participation, and personal and environmental factors. Yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. / Objective. The primary objective of this doctoral thesis was to describe OT and PT practices for young children with CP in the Province of Quebec, Canada. / Methods. This was a cross-sectional, multi-centered survey. All eligible and consenting pediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points---18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability, and Health (ICF). Literature review of pediatric assessments and interventions potentially used for CP was done to determine their level of evidence of effectiveness. In addition, two expert groups provided, for each vignette, a best practice problem identification list and a best practice intervention list. / Results. A total of 62 PTs (83.8% participation rate) and 85 OTs (91.4% participation rate) participated in the study. Overall, 91.9% of PTs and 67.1% of OTs reported using at least one standardized pediatric assessment for at least one vignette. OT and PT interventions focused primarily on impairments and primary function, with less attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice. Wide variations and gaps were identified in therapists' responses suggesting the need for a basic standard of PT and OT management as well as strategies to encourage knowledge dissemination regarding current best practice. Further, implementation of evidence-based practice necessitates more collaboration between researchers, clinicians and administrators.

Approximately one percent of the population in North America suffers from burns every year. However, information concerning the long-term functional recovery of burn survivors remains limited. Therefore, the main objective of this study was to examine the effects of burns on quadriceps muscle endurance and fatigue recovery by comparing healed major burn survivors with healthy matched individuals. Muscle endurance was measured by the number of intermittent submaximal isometric contractions completed during two standard fatigue protocols (SFPs). Recovery from fatigue was monitored for 10 minutes using the interpolated twitch technique. Parameters that were collected at baseline and post SFPs included maximum voluntary contraction (MVC) force, muscle activation level, twitch tension (Pt), compound muscle action potential (M-wave) amplitude, and activity of agonist (vastus medialis)/antagonist(biceps femoris) muscles. Results revealed a lower endurance level in major burn survivors than in matched individuals. The differential detrimental effects of fatigue on Pt and MVC force indicated excitation-contraction uncoupling as the major underlying cause of fatigue in both groups. In addition, neuromuscular propagation impairment, decreased muscle membrane excitability and increased antagonist activity may contribute to the decrease in force generating capacity in major burn survivors. Further research is needed to examine the residual physical limitations from major burn injuries and their effects on quality of life.

A series of studies were conducted to investigate differences in voluntary and evoked contractile properties of trained, untrained and previously immobilized ankle fracture subjects before and following fatigue. Measurements included twitch contractile properties, maximal voluntary contractions (MVC), electromyography (EMG) and muscle activation (interpolated twitch (IT) ratio and second order polynomials). Although second order polynomials were found to be a more precise measurement of muscle activation ($ sim$6% error) than the IT ratio (superimposed evoked torque/potentiated resting evoked torque), both techniques provided a general estimate of muscle activation before and following fatigue. Prior to fatigue, trained plantarflexor subjects exerted greater force (17.5%) and had significantly less antagonist activity (41.3%) than untrained subjects. Following fatigue, untrained subjects experienced greater deficits in excitation-contraction coupling and increased antagonist activity (58%) contributing to their tendency for increased fatiguability. The lower force output (45.8%) and muscle activation (20.4%) of previously immobilized non-fixated ankle fractures did not result in greater fatiguability than controls. Disuse adaptations such as potentiation of the muscle action potentials and twitch torque helped to maintain the fatiguing contractions. However the more severely fractured ankles of the internally-fixated subjects experienced increased agonist (13%) and antagonist (8.5%) EMG activity and similar changes in muscle activation and evoked contractile properties while performing fewer contractions. This would suggest that injuries of greater severity may result in an intrinsically more fatiguable muscle. To determine whether the findings could be generalized to other muscles and fatigue protocols, various contraction intensities were used to elicit short and long duration fatiguing contractions in the plantarflexors and quadriceps. Muscle activation, and t

ABSTRACT Background: Agriculture is identified as being one of the most hazardous industries in Canada. The different types of injuries that Canadian farmers experience have been addressed by other academic researchers. However, Canada does not have any national database that captures the overall prevalence of disability among farmers, regardless of the cause of their disability. Henceforth, this study provides a profile of Canadian farmers with disabilities in 2001 and in 2006. Purpose: The overall purpose of this study was to determine and compare the prevalence of disability among the adult Canadian farming population in two time periods, 2001 and 2006. Specific, objectives were to analyze the differences in age, gender, type of disability, severity of disability, and accessibility to health and social services among farmers with disabilities. Methods: This cross-sectional secondary data analysis focused on the prevalence of disability within the Canadian farming population. Adult data were retrieved from two Statistics Canada national surveys known as the Participation and Activity Limitations Survey (PALS) 2001 and PALS 2006. Microdata from the PALS 2001 and PALS 2006 were accessed through the Research Data Centre at the University of Manitoba. Results: Approximately 10% of Canadian farmers self-reported one or more activity limitation in 2001 and this figure increased to 20.3% in 2006. On the provincial level, the greatest proportion of farmers living with disabilities is situated in Ontario (27.92% in 2001; 27.04% in 2006), Alberta (17.14% in 2001; 26.12% in 2006), Manitoba (7.9% in 2001; 10.43% in 2006), and Quebec (7.52% in 2001; 10.16% in 2006). This study also reveals the prevalence of disability in both 2001 and 2006. The prevalence of disability is greatest among the senior farmers, i.e., those 65 years of age or older. Of all the Canadian farmers aged 65 and older, 28.1% reported experiencing a disability in 2001 and this prevalence increased to 47.2% in 2006. Of all reported disabilities in the Canadian farming community, physical disabilities accounted for 78.08% in 2001 and 59.04% in 2006. “Mild degree of severity” was the leading degree of severity in 2001 (56.98%) and 2006 (39.09%). Conclusion: One of the most significant findings suggests that there has been a significant increase in disability among Canadian farmers over five years’ time, especially among those over 65 years of age or older. The results from this study raise awareness of specific issues such as aging among Canadian farmers with disability, increasing prevalence of disability, and accessibility to health care and social services. This study concludes that future research should be directed toward the impact of disabilities in the agricultural community to guide health professionals and policy makers in designing cost-effective programs suited to Canadian farmers with disabilities.