The purpose of this study was to operationalize the coronary care patient's concept of hope. Analysis of 25 subjects' responses to an open interview format suggested that the sample's definition of hope revolved around five categories. These categories were: 1) theistic beliefs: 2) knowledge that they would not die, require surgery, or experience pain; 3) a wish not to die; 4) a wish to get better; and, 5) confidence that they would get better. Furthermore, significant differences in: 1) the sample's definition of hope: 2) the feelings associated with admission to the coronary care unit: and, 3) the factors that positively influenced the sample's level of hope were directly related to the subject's age.

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There is abundant evidence to support the role of exercise in the well being of community-dwelling elderly people. However, the role of cessation of exercise specifically in institutionalized populations has not been addressed in depth. / The effectiveness of exercise programs has mainly been analysed as a function of physical performance, when many of the benefits of exercising in the elderly appear to belong in the bio-psychosocial domain. Additionally, the effects of non-continuous exercise on physical function are not fully understood. / Twenty-nine residents of Ste-Anne's Hospital were participants in a scheduled, physiotherapy-led exercise program. Twenty-five completed testing on physical performance and bio-psychosocial function at four evaluation times around two repetitions of a 12-week exercise class intervention separated by a 12-week period of no exercise. Physical function of the high level group was measured with the 2-Minute Walk Test and gait speed, whereas the performance of the lower level group was monitored with the Physiotherapy Functional Mobility Profile and a measure of activities of daily living. / Results. Cessation of exercise was associated with deterioration in physical performance in both the higher and the lower level groups. Furthermore, in the lower functioning group, deterioration in physical function occurred over the time period of the study. Bio-psychosocial characteristics illustrated a small deterioration following cessation of exercise. / Conclusions. These findings support the need to replicate this study with a larger sample size. In spite of limiting factors, it does appear that a modification of current practices in exercise programming for older, institutionalized people, would be beneficial to this population, and would increase alignment with recommended best practices based on research with other populations of older adults.

The purpose of this study was to determine the timing and extent of gains in strength, mobility, balance and functional status that follow a high-intensity strengthening program offered to two groups of institutionalized elderly subjects. Thirty two subjects were randomly selected and classified as a person with a HIGH or LOW mobility based on the timed "Up and Go" (TUG) score (<20 sec or &ge;20 sec respectively). The hypothesis was that the exercise regimen would have a greater impact on the LOW mobility group as compared to the HIGH mobility group. Dynamic strength, mobility, balance and functional level were evaluated by the one repetition maximum (IRM), TUG and average walking speed, Berg balance scale and the Physiotherapy Clinical Outcomes Variables (COVS) respectively. Following the 12 week intervention, strength increased in both the LOW and HIGH mobility group (121% and 81% respectively; p < 0.05), whereas balance improved only in the LOW mobility group (49%, p < 0.05). The mobility and functional level of the subjects did not change in either group. In conclusion, the high-intensity strength training was found to have a larger impact on the strength and balance of the LOW mobility group. However, in view of the small sample size and the presence of comorbidity the 12 week program failed to bring about gains in mobility or function.

Purpose: The purpose of this study was to explore the experience of individuals who are aging with a lifelong and/or early-onset physical impairment. Method: A qualitative methodology was utilized consisting of narrative inquiry informed by the Life Course Perspective. The life course perspective is a dynamic approach that encompasses multiple theories including sociology, human development, and aging, highlighting how social, historical, and cultural contexts shape people’s lives. Narratives are storied ways of knowing and communicating that people use to organize events in their lives and make sense out of their experiences. Nine community-dwelling individuals (3 men; 6 women), aged 26-70, with mild to severe Cerebral Palsy were recruited using a combination of purposive and snowball sampling. Multiple (3-4), in-depth interviews were completed with each participant in order to co-construct their life stories. The data analysis was iterative. NVIVO 8 was used to organize the data, supporting a systematic caparison of emerging themes and categories, as well as the central plot that weaves the participants’ experiences together. Findings: “Defying the Odds” emerged as the central narrative that weaved together their experience of growing up and growing older. Their narrative is depicted through the trajectory of the disordered body that manifests itself in peaks and valleys. Their narrative is also weaved together by three central threads: Achieving a Sense of Belonging, Overcoming being Seen but not Heard, and Striving for Self-Reliance. “Normalization” emerged as a key recurring theme in the participants’ life stories. The focus of rehabilitation on "normalizing" movement, particularly walking, during childhood can lead to social psychological challenges as well as problems later in the life course as people encounter increasing fatigue and decreasing functional abilities but no longer have access to rehabilitation services. Implications: Theoretically, the disordered body needs to be reconceptualized in ways that are more positive. Conceptualizing a theory on aging with disability needs to be pursued. Clinically, we need to work towards developing a continuum of care across the life course with a focus on long-term maintenance and prevention of secondary health problems.

This thesis proposes a method for the design of a real-time neuro-fuzzy trajectory generator for the robotic rehabilitation of patients with upper limb dysfunction due to neurological diseases. The system utilizes a fuzzy-logic schema to introduce compliance into the human-robot interaction, and to allow the emulation of a wide variety of therapy techniques. This approach also allows for the fine-tuning of system dynamics using linguistic variables. The rule base for the system is trained using a fuzzy clustering algorithm and applied to experimental data gathered during traditional therapy sessions. The compliance rule base is combined with a hybrid neuro-fuzzy compensator to automatically tune the dynamics of the system. The trajectory generator is packaged as a platform-independent solution to facilitate the rehabilitation of patients using multiple manipulator configurations.

This thesis proposes a method for the design of a real-time neuro-fuzzy trajectory generator for the robotic rehabilitation of patients with upper limb dysfunction due to neurological diseases. The system utilizes a fuzzy-logic schema to introduce compliance into the human-robot interaction, and to allow the emulation of a wide variety of therapy techniques. This approach also allows for the fine-tuning of system dynamics using linguistic variables. The rule base for the system is trained using a fuzzy clustering algorithm and applied to experimental data gathered during traditional therapy sessions. The compliance rule base is combined with a hybrid neuro-fuzzy compensator to automatically tune the dynamics of the system. The trajectory generator is packaged as a platform-independent solution to facilitate the rehabilitation of patients using multiple manipulator configurations.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

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