Vincent Akana Depaul - Academia.edu (original) (raw)

Papers by Vincent Akana Depaul

BACKGROUND The majority of older adults want to age in place, in their homes and communities. How... more BACKGROUND The majority of older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently due to a lack of supports that allow for aging-in-place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer one approach to help older adults age in place. While qualitative studies have examined the experiences of NORC-SSP participants, little is known how participation in NORC-SSP programming affects participants’ social networks. OBJECTIVE This study aims to explore the experiences of thirteen NORC-SSP residents and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. METHODS Semi-structured qualitative interviews were conducted with participants in four NORC communities in Ontario, Canada. Social network theory informed the interview guide and thematic analysis. RESULTS Three main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and the self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). CONCLUSIONS Naturally occurring retirement communities offer an ideal opportunity to build strong communities that provide deep, meaningful social connections that expand their social networks. NORC-SSPS programs can support healthy aging and allow older adults to age-in-place.

Biomedical Engineering Online, Jul 9, 2023

Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor ... more Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010-2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users' function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users' needs.

Disability and Rehabilitation, Apr 21, 2022

PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) fo... more PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation. MATERIALS AND METHODS Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit. RESULTS 40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials. CONCLUSIONS This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.

Physiotherapy Canada, Jul 1, 2009

Journal of stroke and cerebrovascular diseases, Oct 1, 2017

Background-Individuals with stroke fall frequently, and no exercise intervention has been shown t... more Background-Individuals with stroke fall frequently, and no exercise intervention has been shown to prevent falls post-stroke. Perturbation-based balance training (PBT), which involves practicing reactions to instability, shows promise for preventing falls in older adults and individuals with Parkinson disease. This study aimed to determine if PBT during in-patient stroke rehabilitation can prevent falls after discharge into the community. Methods-Individuals with sub-acute stroke completed PBT as part of routine in-patient rehabilitation (n=31). Participants reported falls experienced in daily life for up to 6 months postdischarge. Fall rates were compared to a matched historical control group (HIS) who did not complete PBT during in-patient rehabilitation. Results-Five of 31 PBT participants, compared to 15/31 HIS participants, reported at least one fall. PBT participants reported 10 falls (0.84 falls per person per year), whereas HIS participants reported 31 falls (2.0 falls per person per year). When controlled for follow-up duration and motor impairment, fall rates were lower in the PBT group than the HIS group (rate ratio: 0.36 [0.15, 0.79]; p=0.016).

Geriatrics & Gerontology International, Jan 20, 2020

The relationship between physical performance and cognition is well established. However, finding... more The relationship between physical performance and cognition is well established. However, findings on the relationship between global cognition and the incidence of functional disability has been inconsistent. Using data from the International Mobility in Aging Study, we investigated the relationship between baseline cognitive function and the incidence of poor physical performance 2 years later. Methods: A total of 1071 community-dwelling participants (aged 64-75 years) from four sites in Canada and Latin America, with a Short Physical Performance Battery score ≥9 at baseline (good performance) were included. We carried out two sets of analyses, measuring cognition with either the Leganés Cognitive Test or the Montreal Cognitive Assessment. We used three logistic regression models, controlling for either no confounders, sociodemographic confounders or sociodemographic and health confounders. The full model was also stratified by site. A score <9 on the Short Physical Performance Battery indicated poor physical performance. Results: In the fully adjusted model, each 1-point increase in the baseline Leganés Cognitive Test score (range 0-32) was associated with a 10% decrease in the odds of incidence of poor physical performance at the 2-year follow-up (P = 0.019). Likewise, each 1-point increase in the baseline Montreal Cognitive Assessment score (range 0-30) was associated with a 16% decrease in the odds of developing poor physical performance (P = 0.005). When stratified by site, the results were significant at the Latin American sites (P = 0.02), but not at the Canadian sites (P = 0.08). Conclusions: Poor baseline cognition is associated with the incidence of poor physical performance in community-dwelling older adults. To prevent physical disability, interventions addressing both cognitive and physical performance are required. Geriatr Gerontol Int 2020; ••: ••-••.

American Journal of Kidney Diseases, Dec 1, 2002

Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise ca... more Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise capacity and reduced muscle strength. This was a single-blind, randomized, placebo-controlled trial of an exercise intervention in hemodialysis patients administered erythropoietin. The intervention consisted of progressive resisted isotonic quadriceps and hamstrings exercise and training on a cycle ergometer three times weekly for 12 weeks. Individuals in the control group underwent a nonprogressive program of range-of-motion exercises. Both groups were observed for an additional 5 months without intervention. Outcomes were assessed without knowledge of treatment assignment at baseline, 12 weeks, and 5 months. A healthy age- and sex-matched sample provided comparative data. Our sample was relatively high functioning, with a mean score on the Physical Function subscale of the Short Form 36 (SF-36) of 76 of 100. At 12 weeks, there were large and statistically significant differences in favor of the experimental group on the submaximal exercise test (14 W; 95% confidence interval, 2 to 26) and muscle strength (45 lb; 95% confidence interval, 9 to 81), but not in the 6-minute walk, symptoms questionnaire, or SF-36. Differences between the intervention and control groups at 12 weeks were not evident on retesting 5 months after the end of the intervention. Compared with the healthy sample, patients were significantly lower functioning on the submaximal exercise test, muscle strength, and 6-minute walk test at baseline. In this high-functioning sample, the exercise program improved physical impairment measures, but had no effect on symptoms or health-related quality of life. The impact on patients with a greater degree of physical dysfunction needs to be rigorously studied.

Innovation in Aging, Nov 1, 2019

Proceedings of the Nutrition Society, 2021

Older adults are the fastest-growing demographic group in Canada (1). Most older adults want to a... more Older adults are the fastest-growing demographic group in Canada (1). Most older adults want to age-in-place within their communities (2). One-third of these community-dwelling older adults in Canada are at malnutrition risk, the risk of poor dietary intake and nutritional status, with consequences including increased frailty, decreased quality of life, increased hospitalization, and higher mortality rates (3). It is therefore important to identify correlates of malnutrition risk, especially as they may be root causes of poor food intake and are amenable to intervention. Participants were recruited from seven naturally occurring retirement communities in the province of Ontario, Canada. Demographic data, social measures, and malnutrition risk scores were collected. Individuals were screened for malnutrition risk using Seniors in the Community: Risk Evaluation for Eating & Nutrition (SCREEN)-14, a valid and reliable tool for screening for malnutrition risk in community-dwelling older adults. Scores range from 0-64, with scores less than 54 indicating malnutrition risk. Social networks were measured using the Lubben Social Network Scale (LSNS) a valid and reliable tool for measuring social networks and engagement; scores range from 0-30, with higher scores indicating greater social engagement. Social Support was measured using the Positive Social Interaction subscale of the MOS Social Support Survey (MOS); scores range from 0-25, with higher numbers indicating greater social support. The MOS has demonstrated validity and reliability. Social participation was measured by asking individuals how frequently they were involved in community activities. Descriptive statistics were calculated for all variables. Spearman's rho and Pearson's correlation coefficient were calculated where appropriate. In total, 128 individuals were screened. SCREEN-14 scores ranged from 19 to 62, with a mean score of 45 (SD = 7.9). LSNS ranged from 0 to 30, with a mean score of 15 (SD = 6.4). MOS scores ranged from 3 to 20, with a mean score of 12 (SD = 4.4). 44.4% of respondents never participated in community activities, 12.6% participated less than once a month, 7.4% twice a month, 16.3% once a week, and 19.6% two to three times a week. Age (r = .302, p = .001), household income (ρ=.255, p = .009), LSNS (ρ=.280, p = .001) and MOS (ρ=.294, p = .001) were all significantly associated with SCREEN-14 score. Frequency of participation in community activities was not associated with SCREEN-14 score. Several social factors are associated with malnutrition risk scores among residents in retirement communities in Ontario, Canada. Participants who were younger, who had lower incomes, lower social engagement and less social support had lower SCREEN-14 scores, indicating that these individuals were at increased malnutrition risk. Addressing social factors may therefore help to improve malnutrition risk scores in members of this population.

Journal of rehabilitation and assistive technologies engineering, 2023

Introduction This study investigated the needs of stroke survivors and therapists, and how they m... more Introduction This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Methods Individual interviews were conducted with stroke survivors ( n = 10) and therapists ( n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Results Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. Conclusion While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors’ perspectives are crucial to designing for the home environment.

JMIR aging, Nov 21, 2022

Background: Most older adults want to age in place, in their homes and communities. However, this... more Background: Most older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently owing to lack of supports that allow for aging in place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer an approach to help older adults age in place. Although qualitative studies have examined the experiences of NORC-SSP participants, little is known about how participation in NORC-SSP programming affects participants' social networks. Objective: This study aimed to explore the experiences of 13 NORC-SSP residents who participated in Oasis Senior Supportive Living (Oasis) and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. Methods: Participants were recruited, using convenience sampling, from 4 naturally occurring retirement communities (NORCs) in Ontario, Canada. All participants (13/13, 100%) had participated in Oasis programming. Semistructured qualitative interviews were conducted with participants. Social network theory informed the interview guide and thematic analysis. Results: In total, 13 participants (n=12, 92% women and n=1, 8% men) were interviewed. These participants were from 4 different NORCs where Oasis had been implemented, comprising 2 midrise apartment buildings, 1 low-rise apartment building, and 1 mobile home community. Overall, 3 main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). Participants noted that Oasis provided them with opportunities to meet new people and broaden their social networks, both within and outside their NORCs. They also indicated that Oasis provided them with meaningful ways to spend their time, including opportunities to socialize and try new activities. Participants stated that participating in Oasis helped to alleviate loneliness and improved their quality of life. They noted that Oasis provided them with a reason to get up in the morning. However, the experiences described by participants may not be reflective of all Oasis members. Those who had positive experiences may have been more likely to agree to be interviewed. Conclusions: On the basis of the participants' interviews, Oasis is an effective aging-in-place model that has been successfully implemented in low-rise apartment buildings, midrise apartment buildings, and mobile home communities. Participating in Oasis allowed participants to expand their social networks and improve their mental health and well-being. Therefore, NORCs may

Canadian Geriatrics Journal, Mar 4, 2019

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministr... more In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a difficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care. Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

Physiotherapy Canada, Nov 30, 2018

Purpose: This article describes the content of and delivery methods for motor learning (ML) educa... more Purpose: This article describes the content of and delivery methods for motor learning (ML) education and the attitudes and beliefs of instructors with regard to how ML is taught in Canadian physical therapy (PT) programmes. Method: A qualitative descriptive design was employed, using an online questionnaire and semi-structured telephone interviews. A descriptive content analysis was used to develop codes and themes. An online search of PT programme Web sites was conducted to supplement missing data and collect information from schools that did not participate in the online questionnaire or interview. Results: Eight individuals representing seven schools completed the questionnaire; six of the eight also completed the interview. Responses conveyed the fact that ML content was fairly consistent across schools and was predominantly situated in the neurological curriculum. Schools differed in the delivery methods used for clinical application of ML content. Respondents believed that ML underlies PT practice and should be integrated throughout the programme. Conclusion: Current instruction may deliver adequate ML content but may not provide optimal opportunities to apply ML principles in a clinical context. Continuing education emerged as one suggestion for remediating clinicians' knowledge-practice gap and facilitating student learning on placement. Only half the eligible PT schools participated, and all were English-language programmes; thus, the findings may not be generalizable to all Canadian programmes. Future work should explore how ML can be integrated into the PT curriculum to promote the application of ML principles across different fields. Students' perspectives on their understanding of ML and ML principles and self-efficacy for entry to practice should also be explored.

BMJ Open, Aug 1, 2018

BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to comple... more BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomized controlled trial.

Innovation in Aging, Nov 1, 2019

Physiotherapy Canada, Aug 1, 2016

Purpose: To describe the knowledge, attitudes, and current practices of Canadian physiotherapists... more Purpose: To describe the knowledge, attitudes, and current practices of Canadian physiotherapists in preventing and managing diabetes. Methods: Members of the Canadian Physiotherapy Association were recruited by email to participate in a Web-based survey. The survey contained 40 items in four domains: demographics and education, attitudes and beliefs, current practices, and knowledge of diabetes. A descriptive analysis was completed for all the response variables from the survey. Results: A total of 401 physiotherapists from 10 provinces and 2 territories participated. Respondents were most confident in providing education about exercise and had decreasing confidence in providing education about managing secondary complications, weight management, blood sugar control, and nutrition, respectively. Only 32.4% of participants offered diabetes management counselling, citing lack of training. Knowledge was generally good, except for activity guidelines. Conclusions: A significant proportion of physiotherapists lack confidence in providing key aspects of care to patients with diabetes. Gaps in clinical practice and knowledge of activity guidelines were also observed. This study highlights the need to review entry-level physiotherapy training and to develop continuing educational opportunities in this area.

Learning to walk again: Use of motor learning principles as a theoretical framework for walking-s... more Learning to walk again: Use of motor learning principles as a theoretical framework for walking-skill training in community dwelling individuals following stroke Introduction: Walking is a complex motor skill embedded in numerous basic and instrumental activities of daily living. Walking dysfunction is one of the most disabling and persistent of stroke-related sequela. Physiotherapists are challenged to provide effective interventions to help patients recover optimal walking-skill after stroke. Theoryand research-derived motor learning principles (MLPs) offer an ideal theoretical framework for the development and evaluation of walking-skill focused interventions. Purpose: To: 1) appraise the degree of adherence to motor learning principles (MLPs) in current post-stroke walking-skill training research; 2) describe the Motor Learning Walking Program (MLWP), a novel, MLPs-framed walking training program; and 3) compare the MLWP to an alternate theory-framed walking-focused intervention in community-dwelling individuals within one year of stroke. Methods: A scoping review methodology was used to identify the prevalent theoretical frameworks in current post-stroke walking training literature, and to appraise the adherence to selected MLPs in walking-focused interventions. A randomized controlled trial (n=71) was conducted to compare the MLWP to a bodyweight supported treadmill training (BWSTT) intervention.

Canadian Journal of Dietetic Practice and Research, Jun 1, 2023

Family Medicine and Community Health, Feb 1, 2023

Objective There were two primary objectives, namely: (1) to determine the social network types th... more Objective There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. Design A retrospective cross-sectional study. Setting Data from the Canadian Longitudinal Study on Aging (CLSA). Participants 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. Results CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. Conclusions Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Proactively screening individuals with restricted social networks may help prevent the progression from nutrition risk to malnutrition.

Context: Naturally occurring retirement communities (NORCs) are unplanned communities with a high... more Context: Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of older residents. Mapping NORCs and understanding their unique sociodemographic characteristics and health utilization patterns can assist primary care teams in supporting older adults by: i) identifying geographical areas of high service need and, ii) developing neighborhood based programs.

BACKGROUND The majority of older adults want to age in place, in their homes and communities. How... more BACKGROUND The majority of older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently due to a lack of supports that allow for aging-in-place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer one approach to help older adults age in place. While qualitative studies have examined the experiences of NORC-SSP participants, little is known how participation in NORC-SSP programming affects participants’ social networks. OBJECTIVE This study aims to explore the experiences of thirteen NORC-SSP residents and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. METHODS Semi-structured qualitative interviews were conducted with participants in four NORC communities in Ontario, Canada. Social network theory informed the interview guide and thematic analysis. RESULTS Three main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and the self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). CONCLUSIONS Naturally occurring retirement communities offer an ideal opportunity to build strong communities that provide deep, meaningful social connections that expand their social networks. NORC-SSPS programs can support healthy aging and allow older adults to age-in-place.

Biomedical Engineering Online, Jul 9, 2023

Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor ... more Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010-2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users' function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users' needs.

Disability and Rehabilitation, Apr 21, 2022

PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) fo... more PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation. MATERIALS AND METHODS Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit. RESULTS 40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials. CONCLUSIONS This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.

Physiotherapy Canada, Jul 1, 2009

Journal of stroke and cerebrovascular diseases, Oct 1, 2017

Background-Individuals with stroke fall frequently, and no exercise intervention has been shown t... more Background-Individuals with stroke fall frequently, and no exercise intervention has been shown to prevent falls post-stroke. Perturbation-based balance training (PBT), which involves practicing reactions to instability, shows promise for preventing falls in older adults and individuals with Parkinson disease. This study aimed to determine if PBT during in-patient stroke rehabilitation can prevent falls after discharge into the community. Methods-Individuals with sub-acute stroke completed PBT as part of routine in-patient rehabilitation (n=31). Participants reported falls experienced in daily life for up to 6 months postdischarge. Fall rates were compared to a matched historical control group (HIS) who did not complete PBT during in-patient rehabilitation. Results-Five of 31 PBT participants, compared to 15/31 HIS participants, reported at least one fall. PBT participants reported 10 falls (0.84 falls per person per year), whereas HIS participants reported 31 falls (2.0 falls per person per year). When controlled for follow-up duration and motor impairment, fall rates were lower in the PBT group than the HIS group (rate ratio: 0.36 [0.15, 0.79]; p=0.016).

Geriatrics & Gerontology International, Jan 20, 2020

The relationship between physical performance and cognition is well established. However, finding... more The relationship between physical performance and cognition is well established. However, findings on the relationship between global cognition and the incidence of functional disability has been inconsistent. Using data from the International Mobility in Aging Study, we investigated the relationship between baseline cognitive function and the incidence of poor physical performance 2 years later. Methods: A total of 1071 community-dwelling participants (aged 64-75 years) from four sites in Canada and Latin America, with a Short Physical Performance Battery score ≥9 at baseline (good performance) were included. We carried out two sets of analyses, measuring cognition with either the Leganés Cognitive Test or the Montreal Cognitive Assessment. We used three logistic regression models, controlling for either no confounders, sociodemographic confounders or sociodemographic and health confounders. The full model was also stratified by site. A score <9 on the Short Physical Performance Battery indicated poor physical performance. Results: In the fully adjusted model, each 1-point increase in the baseline Leganés Cognitive Test score (range 0-32) was associated with a 10% decrease in the odds of incidence of poor physical performance at the 2-year follow-up (P = 0.019). Likewise, each 1-point increase in the baseline Montreal Cognitive Assessment score (range 0-30) was associated with a 16% decrease in the odds of developing poor physical performance (P = 0.005). When stratified by site, the results were significant at the Latin American sites (P = 0.02), but not at the Canadian sites (P = 0.08). Conclusions: Poor baseline cognition is associated with the incidence of poor physical performance in community-dwelling older adults. To prevent physical disability, interventions addressing both cognitive and physical performance are required. Geriatr Gerontol Int 2020; ••: ••-••.

American Journal of Kidney Diseases, Dec 1, 2002

Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise ca... more Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise capacity and reduced muscle strength. This was a single-blind, randomized, placebo-controlled trial of an exercise intervention in hemodialysis patients administered erythropoietin. The intervention consisted of progressive resisted isotonic quadriceps and hamstrings exercise and training on a cycle ergometer three times weekly for 12 weeks. Individuals in the control group underwent a nonprogressive program of range-of-motion exercises. Both groups were observed for an additional 5 months without intervention. Outcomes were assessed without knowledge of treatment assignment at baseline, 12 weeks, and 5 months. A healthy age- and sex-matched sample provided comparative data. Our sample was relatively high functioning, with a mean score on the Physical Function subscale of the Short Form 36 (SF-36) of 76 of 100. At 12 weeks, there were large and statistically significant differences in favor of the experimental group on the submaximal exercise test (14 W; 95% confidence interval, 2 to 26) and muscle strength (45 lb; 95% confidence interval, 9 to 81), but not in the 6-minute walk, symptoms questionnaire, or SF-36. Differences between the intervention and control groups at 12 weeks were not evident on retesting 5 months after the end of the intervention. Compared with the healthy sample, patients were significantly lower functioning on the submaximal exercise test, muscle strength, and 6-minute walk test at baseline. In this high-functioning sample, the exercise program improved physical impairment measures, but had no effect on symptoms or health-related quality of life. The impact on patients with a greater degree of physical dysfunction needs to be rigorously studied.

Innovation in Aging, Nov 1, 2019

Proceedings of the Nutrition Society, 2021

Older adults are the fastest-growing demographic group in Canada (1). Most older adults want to a... more Older adults are the fastest-growing demographic group in Canada (1). Most older adults want to age-in-place within their communities (2). One-third of these community-dwelling older adults in Canada are at malnutrition risk, the risk of poor dietary intake and nutritional status, with consequences including increased frailty, decreased quality of life, increased hospitalization, and higher mortality rates (3). It is therefore important to identify correlates of malnutrition risk, especially as they may be root causes of poor food intake and are amenable to intervention. Participants were recruited from seven naturally occurring retirement communities in the province of Ontario, Canada. Demographic data, social measures, and malnutrition risk scores were collected. Individuals were screened for malnutrition risk using Seniors in the Community: Risk Evaluation for Eating & Nutrition (SCREEN)-14, a valid and reliable tool for screening for malnutrition risk in community-dwelling older adults. Scores range from 0-64, with scores less than 54 indicating malnutrition risk. Social networks were measured using the Lubben Social Network Scale (LSNS) a valid and reliable tool for measuring social networks and engagement; scores range from 0-30, with higher scores indicating greater social engagement. Social Support was measured using the Positive Social Interaction subscale of the MOS Social Support Survey (MOS); scores range from 0-25, with higher numbers indicating greater social support. The MOS has demonstrated validity and reliability. Social participation was measured by asking individuals how frequently they were involved in community activities. Descriptive statistics were calculated for all variables. Spearman's rho and Pearson's correlation coefficient were calculated where appropriate. In total, 128 individuals were screened. SCREEN-14 scores ranged from 19 to 62, with a mean score of 45 (SD = 7.9). LSNS ranged from 0 to 30, with a mean score of 15 (SD = 6.4). MOS scores ranged from 3 to 20, with a mean score of 12 (SD = 4.4). 44.4% of respondents never participated in community activities, 12.6% participated less than once a month, 7.4% twice a month, 16.3% once a week, and 19.6% two to three times a week. Age (r = .302, p = .001), household income (ρ=.255, p = .009), LSNS (ρ=.280, p = .001) and MOS (ρ=.294, p = .001) were all significantly associated with SCREEN-14 score. Frequency of participation in community activities was not associated with SCREEN-14 score. Several social factors are associated with malnutrition risk scores among residents in retirement communities in Ontario, Canada. Participants who were younger, who had lower incomes, lower social engagement and less social support had lower SCREEN-14 scores, indicating that these individuals were at increased malnutrition risk. Addressing social factors may therefore help to improve malnutrition risk scores in members of this population.

Journal of rehabilitation and assistive technologies engineering, 2023

Introduction This study investigated the needs of stroke survivors and therapists, and how they m... more Introduction This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Methods Individual interviews were conducted with stroke survivors ( n = 10) and therapists ( n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Results Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. Conclusion While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors’ perspectives are crucial to designing for the home environment.

JMIR aging, Nov 21, 2022

Background: Most older adults want to age in place, in their homes and communities. However, this... more Background: Most older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently owing to lack of supports that allow for aging in place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer an approach to help older adults age in place. Although qualitative studies have examined the experiences of NORC-SSP participants, little is known about how participation in NORC-SSP programming affects participants' social networks. Objective: This study aimed to explore the experiences of 13 NORC-SSP residents who participated in Oasis Senior Supportive Living (Oasis) and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. Methods: Participants were recruited, using convenience sampling, from 4 naturally occurring retirement communities (NORCs) in Ontario, Canada. All participants (13/13, 100%) had participated in Oasis programming. Semistructured qualitative interviews were conducted with participants. Social network theory informed the interview guide and thematic analysis. Results: In total, 13 participants (n=12, 92% women and n=1, 8% men) were interviewed. These participants were from 4 different NORCs where Oasis had been implemented, comprising 2 midrise apartment buildings, 1 low-rise apartment building, and 1 mobile home community. Overall, 3 main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). Participants noted that Oasis provided them with opportunities to meet new people and broaden their social networks, both within and outside their NORCs. They also indicated that Oasis provided them with meaningful ways to spend their time, including opportunities to socialize and try new activities. Participants stated that participating in Oasis helped to alleviate loneliness and improved their quality of life. They noted that Oasis provided them with a reason to get up in the morning. However, the experiences described by participants may not be reflective of all Oasis members. Those who had positive experiences may have been more likely to agree to be interviewed. Conclusions: On the basis of the participants' interviews, Oasis is an effective aging-in-place model that has been successfully implemented in low-rise apartment buildings, midrise apartment buildings, and mobile home communities. Participating in Oasis allowed participants to expand their social networks and improve their mental health and well-being. Therefore, NORCs may

Canadian Geriatrics Journal, Mar 4, 2019

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministr... more In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a difficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care. Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

Physiotherapy Canada, Nov 30, 2018

Purpose: This article describes the content of and delivery methods for motor learning (ML) educa... more Purpose: This article describes the content of and delivery methods for motor learning (ML) education and the attitudes and beliefs of instructors with regard to how ML is taught in Canadian physical therapy (PT) programmes. Method: A qualitative descriptive design was employed, using an online questionnaire and semi-structured telephone interviews. A descriptive content analysis was used to develop codes and themes. An online search of PT programme Web sites was conducted to supplement missing data and collect information from schools that did not participate in the online questionnaire or interview. Results: Eight individuals representing seven schools completed the questionnaire; six of the eight also completed the interview. Responses conveyed the fact that ML content was fairly consistent across schools and was predominantly situated in the neurological curriculum. Schools differed in the delivery methods used for clinical application of ML content. Respondents believed that ML underlies PT practice and should be integrated throughout the programme. Conclusion: Current instruction may deliver adequate ML content but may not provide optimal opportunities to apply ML principles in a clinical context. Continuing education emerged as one suggestion for remediating clinicians' knowledge-practice gap and facilitating student learning on placement. Only half the eligible PT schools participated, and all were English-language programmes; thus, the findings may not be generalizable to all Canadian programmes. Future work should explore how ML can be integrated into the PT curriculum to promote the application of ML principles across different fields. Students' perspectives on their understanding of ML and ML principles and self-efficacy for entry to practice should also be explored.

BMJ Open, Aug 1, 2018

BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to comple... more BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomized controlled trial.

Innovation in Aging, Nov 1, 2019

Physiotherapy Canada, Aug 1, 2016

Purpose: To describe the knowledge, attitudes, and current practices of Canadian physiotherapists... more Purpose: To describe the knowledge, attitudes, and current practices of Canadian physiotherapists in preventing and managing diabetes. Methods: Members of the Canadian Physiotherapy Association were recruited by email to participate in a Web-based survey. The survey contained 40 items in four domains: demographics and education, attitudes and beliefs, current practices, and knowledge of diabetes. A descriptive analysis was completed for all the response variables from the survey. Results: A total of 401 physiotherapists from 10 provinces and 2 territories participated. Respondents were most confident in providing education about exercise and had decreasing confidence in providing education about managing secondary complications, weight management, blood sugar control, and nutrition, respectively. Only 32.4% of participants offered diabetes management counselling, citing lack of training. Knowledge was generally good, except for activity guidelines. Conclusions: A significant proportion of physiotherapists lack confidence in providing key aspects of care to patients with diabetes. Gaps in clinical practice and knowledge of activity guidelines were also observed. This study highlights the need to review entry-level physiotherapy training and to develop continuing educational opportunities in this area.

Learning to walk again: Use of motor learning principles as a theoretical framework for walking-s... more Learning to walk again: Use of motor learning principles as a theoretical framework for walking-skill training in community dwelling individuals following stroke Introduction: Walking is a complex motor skill embedded in numerous basic and instrumental activities of daily living. Walking dysfunction is one of the most disabling and persistent of stroke-related sequela. Physiotherapists are challenged to provide effective interventions to help patients recover optimal walking-skill after stroke. Theoryand research-derived motor learning principles (MLPs) offer an ideal theoretical framework for the development and evaluation of walking-skill focused interventions. Purpose: To: 1) appraise the degree of adherence to motor learning principles (MLPs) in current post-stroke walking-skill training research; 2) describe the Motor Learning Walking Program (MLWP), a novel, MLPs-framed walking training program; and 3) compare the MLWP to an alternate theory-framed walking-focused intervention in community-dwelling individuals within one year of stroke. Methods: A scoping review methodology was used to identify the prevalent theoretical frameworks in current post-stroke walking training literature, and to appraise the adherence to selected MLPs in walking-focused interventions. A randomized controlled trial (n=71) was conducted to compare the MLWP to a bodyweight supported treadmill training (BWSTT) intervention.

Canadian Journal of Dietetic Practice and Research, Jun 1, 2023

Family Medicine and Community Health, Feb 1, 2023

Objective There were two primary objectives, namely: (1) to determine the social network types th... more Objective There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. Design A retrospective cross-sectional study. Setting Data from the Canadian Longitudinal Study on Aging (CLSA). Participants 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. Results CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. Conclusions Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Proactively screening individuals with restricted social networks may help prevent the progression from nutrition risk to malnutrition.

Context: Naturally occurring retirement communities (NORCs) are unplanned communities with a high... more Context: Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of older residents. Mapping NORCs and understanding their unique sociodemographic characteristics and health utilization patterns can assist primary care teams in supporting older adults by: i) identifying geographical areas of high service need and, ii) developing neighborhood based programs.