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<p><strong>Introduction:</strong> Children with acquired brain injury (ABI) receive physiotherapy interventions to promote motor skill relearning. Theoretically-driven motor learning strategies (MLS) may support therapists in this goal, but their use with this complex population is unexplored. Virtual reality (VR) games are popular interventions that may influence therapist use of MLS. A valid, reliable method to examine MLS during usual and VR-based interventions is required.</p> <p><strong>Purpose: </strong>To: 1) identify the active ingredients of VR interventions; 2) develop and examine the psychometric properties of an instrument to measure MLS use; and 3) explore physiotherapists’ perspectives on promoting motor learning within usual and VR-based interventions for children with ABI.</p> <p><strong>Methods:</strong> A scoping review methodology was used to identify the active ingredients of VR interventions. Nineteen experts and clinicians participated in a content validation process to develop an instrument to measure MLS. Inter-rater reliability of the instrument was evaluated within 22 videotaped usual and VR-based physiotherapy sessions with children with ABI. Six therapists participated in qualitative interviews about these interventions.</p> <p><strong>Results:</strong> The scoping review identified<em> </em>11 active ingredients of VR; 6 related to motor learning theory. The Motor Learning Strategy Rating Instrument (MLSRI) was developed. Inter-rater reliability was high (0.81) for usual interventions but low (0.28) for VR-based interventions. Therapists described the importance of considering intervention goals and child characteristics when promoting motor learning; VR was viewed as a complex, motivating intervention that influenced their use of verbal strategies.</p> <p><strong>Conclusions:</strong> A motor learning theoretical framework may be relevant to clinicians and researchers using VR in pediatric rehabilitation. Qualitative findings enhance understanding of how therapists promote motor learning in usual and VR-based physiotherapy interventions for children withABI. The use of MLS can be measured reliably within usual interventions, but further instrument refinements are required to rate MLS use within VR-based physiotherapy for children with ABI.</p> / Doctor of Philosophy (PhD)

<p>The accurate diagnosis of disorders of consciousness presents substantial difficulty because of the reliance on behaviour-based assessment tools. A patient may be covertly aware but unable to indicate their state due to physical impairments. Neuroimaging researchers have begun to seek alternate methods of assessment that rely on brain responses rather than behavioural ones. To this end, mental imagery has been employed as a voluntary cognitive activity that can be measured with fMRI or EEG to indicate awareness. In this dissertation I examine the advantages and limitations of these two imaging techniques and argue that EEG is more suitable for this patient population. I expand upon existing mental imagery research by exploring additional tasks that have not been applied to this problem, in order to address three previously unanswered questions that are central to the development of imagery-based diagnostic tools. First, do individuals differ on which imagery tasks produce the most reliable activation? Second, can the robustness of brain activation during imagery be predicted from familiarity with the imagined activity? Third, do fMRI and EEG provide converging evidence about individual imagery performance? In order to answer these questions, 6 mental imagery tasks were examined using simultaneous EEG and fMRI recordings, in combination with participant ratings. The findings revealed that, of the mental imagery tasks studied, mental arithmetic consistently produced the most robust activation at the single subject level. Additionally, there was no relationship between participants’ familiarity with an activity and the level of brain activation during performance. The key finding demonstrated that EEG and fMRI were in agreement on both of these questions, lending support to the increasing use of EEG over fMRI in disorders of consciousness.</p> / Doctor of Philosophy (PhD)

<p>This thesis examines how ERP responses to music provide an index of emotion in control, alexithymic, depressed and depressed alexithymic individuals using a musical affective priming task, with the objective being its clinical application to assess emotion in brain injured patients. Participants listened to pairs of music primes and music targets (music-music paradigm) and word targets (music-word paradigm) to mentally decide if they matched or not according to emotional valence (happy, sad). Responses manifested in the N300 (emotional categorization), P300 (emotional recognition) and N400 (emotional meaning) ERP components, with larger and more differentiated responses for the music-word paradigm indicating a less automatic nature than the music-music paradigm. Alexithymic individuals showed disrupted responses for all components for sad word targets, indicating a sequence of disconnects producing their decreased awareness of and difficulty with regulating emotion. Depressed participants displayed an emotional negativity bias for sad word targets in the P300 and N400, attributable to difficulty disengaging (cognitive rumination), reflecting how emotional deficits affect awareness. Disrupted P300 and N400 responses in the depressed alexithymic individuals were isolated to alexithymia rather than the emotional negativity bias. Specific processing deficits of happy music targets found only in depressed alexithymic individuals demonstrate how alexithymia increases the severity of depression. Although depression effects are more pervasive, alexithymia modifies depressive effects in emotional regulation. The P300 was most reliably seen in depression, and alexithymia to a lesser extent. Therefore, ERP responses to music can effectively and covertly measure emotion and different levels of automaticity, alexithymia and depression. This thesis is the first to demonstrate: 1) how music conveys emotion in a pure musical context (music-music); 2) musical emotion perception in alexithymia, depression and depressed alexithymia; 3) an effective non-verbal measure of emotion for assessing emotional states in brain injured populations.</p> / Doctor of Philosophy (PhD)