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Introduction Post-stroke activity limitation secondary to upper-extremity motor impairment is common, and increasing. We do not currently have effective, globally applicable interventions to improve activity limitation. The burden of post-stroke disability is rising in low and middle-income countries, resulting in an immediate need for effective interventions that can be implemented throughout the world. Purpose This program of research was structured to address three important questions, 1) In all parts of the world, do people with stroke experience similar degrees of activity limitation secondary to upper extremity motor impairment? 2) Are there simple interventions that can be initiated by health care workers, but autonomously sustained by people with stroke, that can improve activity limitation secondary to upper extremity motor impairment? and 3) Are these interventions effective? Methods To address the first question, data from an international stroke study were used to quantify the amount of post-stroke upper extremity weakness and characterize the people. For the second question, a systematic review was conducted to identify current evidence on the effectiveness of simple, task-based practice. To address the third question a protocol was developed for an outcome study. Results Post-stroke upper extremity weakness is common throughout the world, ranging from 67.3% of those with stroke in high-income countries to 97.3% in low-income countries. There is inconclusive, but promising evidence on the effectiveness of simple, task-based practice to improve upper-extremity motor impairment. It is likely that multiple interventions are needed to address the problem and a two-by-two factorial design trial, evaluating simple, task-based practice or a motor enhancing pharmacological agent, implemented in all regions of the world, would be a novel and efficient means of addressing the question. Conclusions The answers to these questions have provided novel information that is a required next step to providing effective, globally applicable interventions for people with stroke. / Thesis / Doctor of Philosophy (PhD) / After having a stroke, more than half the people have difficulty moving their arm. This difficulty often results in difficulties doing every day tasks. Most of the information on what happens after stroke comes from developed countries and we do not know if these problems exist to the same extent in developed countries. We also do not know the most effective interventions to help improve arm function after stroke. Possible interventions could include rehabilitation strategies, drugs or a combination of both. This thesis describes the amount of arm weakness after stroke throughout the world, looks at the evidence for a simple intervention that could be used throughout the world, and describes the design of study that could look at the effectiveness of both rehabilitation and drug interventions throughout the world. This work provides information on the globally applicable interventions to improve arm function after stroke, which has not been considered in the literature to date.

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Yes / Dementia is a serious, progressive, and often debilitating illness with no known cure, having a severe adverse effect on memory, behaviour, reasoning, and communication. A comprehensive review of current refereed research material in the use of games in this area is scarce and suffers from being orientated towards commercially available games or derivatives such as “Dr. Kawashima’s brain training.” There is much lesser concern for bespoke research grade alternatives. This review will attempt to assess the current state of the art in research orientated games for dementia, importantly identifying systems capable of prediction before the onset of the disease. It can be ascertained from the literature reviewed that there are clearly a large number of interactive computer game based mechanisms used for dementia. However, these are each highly intrusive in terms of affecting normal living and the patient is aware of being tested; furthermore their long-term or real benefits are unknown as is their effect over conventional tests. It is important to predict cognitive impairment at a stage early enough to maximise benefit from treatment and therapeutic intervention. Considering the availability, use, and increasing power of modern mobile smartphones, it is logically plausible to explore this platform for dementia healthcare.

Patients returning to sport after anterior cruciate ligament (ACL) reconstruction surgery currently have a high risk for sustaining a second ACL injury and having early signs of knee osteoarthritis. Assessing lower extremity kinetics and kinematics during landing can provide information about a patient's risk for sustaining a second ACL injury and having further joint trauma. However, currently accepted methods to assess kinetics and kinematics are not feasible to use in most non-research settings as they are expensive, time consuming, and take up a lot of space. The goal of this project was to identify methods to assess landing mechanics which are reliable and feasible to use in non-research settings. First, we found that the loadsol®, a wireless force sensing shoe insole, is valid relative to embedded force plates and repeatable between days for assessing kinetics and kinetic symmetry during bilateral and unilateral landing tasks. Second, we developed a new method to collect continuous kinematic data using a low-cost videocamera, disposable markers, and an automated point tracking program. This method was validated against a 3D motion capture system for measuring a fixed angle and for measuring sagittal plane running kinematics. Third, we found that the new video analysis method is valid relative to 3D motion capture and is repeatable between days for assessing frontal and sagittal plane knee kinematics during landing. Finally, we used the loadsol® and automated 2D video analysis to assess landing mechanics in both patients following ACL reconstruction and healthy uninjured control participants in a non-research setting. We found that, relative to controls, patients following ACL reconstruction had reduced kinetic symmetry during bilateral landing, where they offloaded their surgical limb and relied more heavily on their non-surgical limb. Additionally, patients following ACL reconstruction had reduced knee flexion range of motion symmetry during unilateral landing, where they had reduced knee flexion when landing on their surgical limb. Collectively, these projects developed methods to quantitatively assess landing mechanics that are feasible to use in non-research settings, documented the validity and between-day repeatability of these methods, and demonstrated that they could be used to identify kinetic and kinematic deficits in patients following ACL reconstruction. This project is an important step toward being able to assess landing mechanics in patients recovering from an ACL reconstruction. / Doctor of Philosophy / The anterior cruciate ligament (ACL) is a bundle of connective tissue that helps stabilize the knee joint. ACL injuries are common in sport, and ACL reconstruction surgery is the most widely used treatment strategy for patients who wish to return to playing sports. Unfortunately, even after ACL surgery and rehabilitation, many patients who return to sport wind up getting hurt again and developing severe joint pain down the road. Previous research has identified movement and loading patterns which are associated with this increased risk for further injury in patients following ACL reconstruction. For example, patients who have increased asymmetry when landing from a jump, where they shift weight away from their surgical limb and towards their non-surgical limb, have an increased likelihood of sustaining a second ACL injury to either their surgical or non-surgical leg. Assessing movement during rehabilitation could help identify patients who exhibit poor movement mechanics and improve movement to reduce their risk for second injuries. However, there are not currently methods available to reliably assess movement that are feasible for widespread use in non-research settings (i.e. physical therapy clinics). The purpose of this project was to identify and develop methods to assess movement which are accurate and feasible to use in a clinical setting. In this dissertation, we first determined the accuracy of using wireless force sensing shoe insoles to measure how hard and how symmetrically people contact the ground when they land from a jump. Second, we developed a new method to measure knee motion using videos collected with low-cost cameras (e.g. iPad), and determined the accuracy of this method compared to a three-dimensional motion capture system. For the last part of this dissertation we demonstrated that the aforementioned methods could be used to identify deficits in landing mechanics in patients following ACL reconstruction in a non-research setting. When comparing ACL reconstruction patients with uninjured controls, we found movement and loading asymmetries which were expected and which are associated with the risk for second ACL injuries and early onset knee osteoarthritis. This project is an important step towards being able to assess landing mechanics in patients recovering from an ACL reconstruction, which could improve our ability to prevent subsequent injuries in this clinical population.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01