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Description
Parkinson's disease (PD) is a neurodegenerative disorder that produces a characteristic set of neuromotor deficits that sometimes includes reduced amplitude and velocity of movement. Several studies have shown that people with PD improved their motor performance when presented with external cues. Other work has demonstrated that high velocity and large amplitude exercises can increase the amplitude and velocity of movement in simple carryover tasks in the upper and lower extremities. Although the cause for these effects is not known, improvements due to cueing suggest that part of the neuromotor deficit in PD is in the integration of sensory feedback to produce motor commands. Previous studies have documented some somatosensory deficits, but only limited information is available regarding the nature and magnitude of sensorimotor deficits in the shoulder of people with PD. The goals of this research were to characterize the sensorimotor impairment in the shoulder joint of people with PD and to investigate the use of visual feedback and large amplitude/high velocity exercises to target PD-related motor deficits. Two systems were designed and developed to use visual feedback to assess the ability of participants to accurately adjust limb placement or limb movement velocity and to encourage improvements in performance of these tasks. Each system was tested on participants with PD, age-matched control subjects and young control subjects to characterize and compare limb placement and velocity control capabilities. Results demonstrated that participants with PD were less accurate at placing their limbs than age-matched or young control subjects, but that their performance improved over the course of the test session such that by the end, the participants with PD performed as well as controls. For the limb velocity feedback task, participants with PD and age-matched control subjects were less accurate than young control subjects, but at the end of the session, participants with PD and age-matched control subjects were as accurate as the young control subjects. This study demonstrates that people with PD were able to improve their movement patterns based on visual feedback of performance and suggests that this feedback paradigm may be useful in exercise programs for people with PD.
ContributorsSmith, Catherine (Author) / Abbas, James J (Thesis advisor) / Ingalls, Todd (Thesis advisor) / Krishnamurthi, Narayanan (Committee member) / Buneo, Christopher (Committee member) / Rikakis, Thanassis (Committee member) / Arizona State University (Publisher)
Created2015
Description
The purpose of this study is to identify the needs of older adults with Alzheimer's disease (AD) and related dementias (ADRD) admitted to a rehabilitation setting where they are expected to physically and mentally function to their optimal level of health. To date, no studies have identified the needs and concerns of ADRD patients in rehabilitation settings. The Needs-Driven Dementia-Compromised Behavior (NDB) Model, the researcher's clinical experience, and the state of the current scientific literature will help guide the study. An exploratory qualitative research approach was employed to gather data and discover new information about the ADRD patient's needs and related behavioral outcomes. The qualitative findings on the discrepancies and similarities in perceptions of ADRD patient needs were obtained by examining formal and informal caregivers' perceptions. The researcher recruited registered nurses and certified nurse assistants (RNs and CNAs, formal) and family/friends (informal) who have provided care to patients in inpatient rehabilitation facilities to participate in focus groups and individualized focused interviews. The data were collated and analyzed using a thematic analysis approach. The overarching theme that developed as a result of this approach revealed discordant perceptions and expectations of ADRD patients' needs between the formal and informal caregivers with six subthemes: communication and information, family involvement, rehabilitation nurse philosophy, nursing care, belonging, and patient outcomes. The researcher provided recommendations to help support these needs. These findings will help guide the development of nurse-lead interventions for ADRD patients in a rehabilitation setting.
ContributorsAllen, Angela Marie (Author) / Coon, David W. (Thesis advisor) / McCarthy, Marianne (Committee member) / Uriri-Glover, Johannah (Committee member) / Arizona State University (Publisher)
Created2014
Description
This dissertation presents a portable methodology for holistic planning and optimization of right of way infrastructure rehabilitation that was designed to generate monetary savings when compared to planning that only considers single infrastructure components. Holistic right of way infrastructure planning requires simultaneous consideration of the three right of way infrastructure components that are typically owned and operated under the same municipal umbrella: roads, sewer, and water. The traditional paradigm for the planning of right way asset management involves operating in silos where there is little collaboration amongst different utility departments in the planning of maintenance, rehabilitation, and renewal projects. By collaborating across utilities during the planning phase, savings can be achieved when collocated rehabilitation projects from different right of way infrastructure components are synchronized to occur at the same time. These savings are in the form of shared overhead and mobilization costs, and roadway projects providing open space for subsurface utilities. Individual component models and a holistic model that utilize evolutionary algorithms to optimize five year maintenance, rehabilitation, and renewal plans for the road, sewer, and water components were created and compared. The models were designed to be portable so that they could be used with any infrastructure condition rating, deterioration modeling, and criticality assessment systems that might already be in place with a municipality. The models attempt to minimize the overall component score, which is a function of the criticality and condition of the segments within each network, by prescribing asset management activities to different segments within a component network while subject to a constraining budget. The individual models were designed to represent the traditional decision making paradigm and were compared to the holistic model. In testing at three different budget levels, the holistic model outperformed the individual models in the ability to generate five year plans that optimized prescribed maintenance, rehabilitation and renewal for various segments in order to achieve the goal of improving the component score. The methodology also achieved the goal of being portable, in that it is compatible with any condition rating, deterioration, and criticality system.
ContributorsCarey, Brad David (Author) / Lueke, Jason S (Thesis advisor) / Ariaratnam, Samuel (Committee member) / Bashford, Howard (Committee member) / Arizona State University (Publisher)
Created2012
Description
In rehabilitation settings, activity limitation can be a significant barrier to recovery. This study sought to examine the effects of state and trait level benefit finding, positive affect, and catastrophizing on activity limitation among individuals with a physician-confirmed diagnosis of either Osteoarthritis (OA), Fibromyalgia (FM), or a dual diagnosis of OA/FM. Participants (106 OA, 53 FM, and 101 OA/FM) who had no diagnosed autoimmune disorder, a pain rating above 20 on a 0-100 scale, and no involvement in litigation regarding their condition were recruited in the Phoenix metropolitan area for inclusion in the current study. After initial questionnaires were completed, participants were trained to complete daily diaries on a laptop computer and instructed to do so a half an hour before bed each night for 30 days. In each diary, participants rated their average daily pain, benefit finding, positive affect, catastrophizing, and activity limitation. A single item, "I thought about some of the good things that have come from living with my pain" was used to examine the broader construct of benefit finding. It was hypothesized that state and trait level benefit finding would have a direct relation with activity limitation and a partially mediated relationship, through positive affect. Multilevel modeling with SAS PROC MIXED revealed that benefit finding was not directly related to activity limitation. Increases in benefit finding were associated, however, with decreases in activity limitation through a significant mediated relationship with positive affect. Individuals who benefit find had a higher level of positive affect which was associated with decreased activity limitation. A suppression effect involving pain and benefit finding at the trait level was also found. Pain appeared to increase the predictive validity of the relation of benefit finding to activity limitation. These findings have important implications for rehabilitation psychologists and should embolden clinicians to encourage patients to increase positive affect by employing active approach-oriented coping strategies like benefit finding to reduce activity limitation.
ContributorsKinderdietz, Jeffrey Scott (Author) / Zautra, Alex (Thesis advisor) / Davis, Mary (Committee member) / Barrera, Manuel (Committee member) / Okun, Morris (Committee member) / Arizona State University (Publisher)
Created2012
Description
Olecranon fractures account for approximately 10% of upper extremity fractures and 95% of them require surgical fixation. Most of the clinical, retrospective and biomechanical studies have supported plate fixation over other surgical fixation techniques since plates have demonstrated low incidence of reoperation, high fixation stability and resumption of activities of daily living (ADL) earlier. Thus far, biomechanical studies have been helpful in evaluating and comparing different plate fixation constructs based on fracture stability. However, they have not provided information that can be used to design rehabilitation protocols such as information that relates load at the hand with tendon tension or load at the interface between the plate and the bone. The set-ups used in biomechanical studies have included simple mechanical testing machines that either measured construct stiffness by cyclic loading the specimens or construct strength by performing ramp load until failure. Some biomechanical studies attempted to simulate tendon tension but the in-vivo tension applied to the tendon remains unknown. In this study, a novel procedure to test the olecranon fracture fixation using modern olecranon plates was developed to improve the biomechanical understanding of failures and to help determine the weights that can be safely lifted and the range of motion (ROM) that should be performed during rehabilitation procedures.
Design objectives were defined based on surgeon's feedback and analysis of unmet needs in the area of biomechanical testing. Four pilot cadaveric specimens were prepared to run on an upper extremity feedback controller and the set-up was validated based on the design objectives. Cadaveric specimen preparation included a series of steps such as dissection, suturing and potting that were standardized and improved iteratively after pilot testing. Additionally, a fracture and plating protocol was developed and fixture lengths were standardized based on anthropometric data. Results from the early pilot studies indicated shortcomings in the design, which was then iteratively refined for the subsequent studies. The final pilot study demonstrated that all of the design objectives were met. This system is planned for use in future studies that will assess olecranon fracture fixation and that will investigate the safety of rehabilitation protocols.
Design objectives were defined based on surgeon's feedback and analysis of unmet needs in the area of biomechanical testing. Four pilot cadaveric specimens were prepared to run on an upper extremity feedback controller and the set-up was validated based on the design objectives. Cadaveric specimen preparation included a series of steps such as dissection, suturing and potting that were standardized and improved iteratively after pilot testing. Additionally, a fracture and plating protocol was developed and fixture lengths were standardized based on anthropometric data. Results from the early pilot studies indicated shortcomings in the design, which was then iteratively refined for the subsequent studies. The final pilot study demonstrated that all of the design objectives were met. This system is planned for use in future studies that will assess olecranon fracture fixation and that will investigate the safety of rehabilitation protocols.
ContributorsJain, Saaransh (Author) / Abbas, James (Thesis advisor) / LaBelle, Jeffrey (Thesis advisor) / Jacofsky, Marc (Committee member) / Arizona State University (Publisher)
Created2015
Description
Progressive gait disorder in Parkinson's disease (PD) is usually exhibited as reduced step/stride length and gait speed. People with PD also exhibit stooped posture, which can contribute to reduced step length and arm swing. Since gait and posture deficits in people with PD do not respond well to pharmaceutical and surgical treatments, novel rehabilitative therapies to alleviate these impairments are necessary. Many studies have confirmed that people with PD can improve their walking patterns when external cues are presented. Only a few studies have provided explicit real-time feedback on performance, but they did not report how well people with PD can follow the cues on a step-by-step basis. In a single-session study using a novel-treadmill based paradigm, our group had previously demonstrated that people with PD could follow step-length and back angle feedback and improve their gait and posture during treadmill walking. This study investigated whether a long-term (6-week, 3 sessions/week) real-time feedback training (RTFT) program can improve overground gait, upright posture, balance, and quality of life. Three subjects (mean age 70 ± 2 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were enrolled and participated in the program. The RTFT sessions involved walking on a treadmill while following visual feedback of step length and posture (one at any given time) displayed on a monitor placed in front of the subject at eye-level. The target step length was set between 110-120% of the step length obtained during a baseline non-feedback walking trial and the target back angle was set at the maximum upright posture exhibited during a quiet standing task. Two subjects were found to significantly improve their posture and overground walking at post-training and these changes were retained six weeks after RTFT (follow-up) and the third subject improved his upright posture and gait rhythmicity. Furthermore, the magnitude of the improvements observed in these subjects was greater than the improvements observed in reports on other neuromotor interventions. These results provide preliminary evidence that real-time feedback training can be used as an effective rehabilitative strategy to improve gait and upright posture in people with PD.
ContributorsBaskaran, Deepika (Author) / Krishnamurthi, Narayanan (Thesis advisor) / Abbas, James (Thesis advisor) / Honeycutt, Claire (Committee member) / Arizona State University (Publisher)
Created2017
Description
Correctional officers are increasingly being trained in evidence-based practices and the willingness of officers to implement what they have learned is crucial for organizational reform. Most of the literature in this area has examined officer attitudes about rehabilitation and punitiveness. Left out are additional characteristics, such as self-control, that may affect an officer’s receptivity to learn and implement new techniques. The present study examines officer receptiveness to motivational interviewing using 280 surveys administered to correctional officers tasked with both delivering and supervising program delivery to inmates within the Arizona Department of Corrections. Three broad questions are asked: 1) Are officer attitudes about punishment associated with receptivity toward implementing rehabilitative techniques? 2) Are officer levels of self-control associated with receptivity toward implementing rehabilitative techniques? and 3) Is the association between officer attitudes toward punishment and receptivity toward implementing rehabilitation techniques moderated by officer self-control? The results suggest that punitiveness and self-control both have statistically significant direct effects on correctional officer receptivity to training and that self-control does not moderate the relationship between punitiveness and receptivity to training. However, these findings could be due to limitations in the present study’s sampling and statistical methods. Policy implications and future research are discussed.
ContributorsSmith, Wesley Thomas (Author) / Wright, Kevin A. (Thesis advisor) / Young, Jacob T.N. (Committee member) / Telep, Cody W. (Committee member) / Arizona State University (Publisher)
Created2018
Description
The generation of walking motion is one of the most vital functions of the human body because it allows us to be mobile in our environment. Unfortunately, numerous individuals suffer from gait impairment as a result of debilitating conditions like stroke, resulting in a serious loss of mobility. Our understanding of human gait is limited by the amount of research we conduct in relation to human walking mechanisms and their characteristics. In order to better understand these characteristics and the systems involved in the generation of human gait, it is necessary to increase the depth and range of research pertaining to walking motion. Specifically, there has been a lack of investigation into a particular area of human gait research that could potentially yield interesting conclusions about gait rehabilitation, which is the effect of surface stiffness on human gait. In order to investigate this idea, a number of studies have been conducted using experimental devices that focus on changing surface stiffness; however, these systems lack certain functionality that would be useful in an experimental scenario. To solve this problem and to investigate the effect of surface stiffness further, a system has been developed called the Variable Stiffness Treadmill system (VST). This treadmill system is a unique investigative tool that allows for the active control of surface stiffness. What is novel about this system is its ability to change the stiffness of the surface quickly, accurately, during the gait cycle, and throughout a large range of possible stiffness values. This type of functionality in an experimental system has never been implemented and constitutes a tremendous opportunity for valuable gait research in regard to the influence of surface stiffness. In this work, the design, development, and implementation of the Variable Stiffness Treadmill system is presented and discussed along with preliminary experimentation. The results from characterization testing demonstrate highly accurate stiffness control and excellent response characteristics for specific configurations. Initial indications from human experimental trials in relation to quantifiable effects from surface stiffness variation using the Variable Stiffness Treadmill system are encouraging.
ContributorsBarkan, Andrew Robert (Author) / Artemiadis, Panagiotis (Thesis director) / Santello, Marco (Committee member) / Barrett, The Honors College (Contributor) / Mechanical and Aerospace Engineering Program (Contributor)
Created2015-05
Description
Robotic rehabilitation for upper limb post-stroke recovery is a developing technology. However, there are major issues in the implementation of this type of rehabilitation, issues which decrease efficacy. Two of the major solutions currently being explored to the upper limb post-stroke rehabilitation problem are the use of socially assistive rehabilitative robots, robots which directly interact with patients, and the use of exoskeleton-based systems of rehabilitation. While there is great promise in both of these techniques, they currently lack sufficient efficacy to objectively justify their costs. The overall efficacy to both of these techniques is about the same as conventional therapy, yet each has higher overhead costs that conventional therapy does. However there are associated long-term cost savings in each case, meaning that the actual current viability of either of these techniques is somewhat nebulous. In both cases, the problems which decrease technique viability are largely related to joint action, the interaction between robot and human in completing specific tasks, and issues in robot adaptability that make joint action difficult. As such, the largest part of current research into rehabilitative robotics aims to make robots behave in more "human-like" manners or to bypass the joint action problem entirely.
ContributorsRamakrishna, Vijay Kambhampati (Author) / Helms Tillery, Stephen (Thesis director) / Buneo, Christopher (Committee member) / Barrett, The Honors College (Contributor) / Economics Program in CLAS (Contributor) / W. P. Carey School of Business (Contributor) / School of Life Sciences (Contributor)
Created2015-05
Description
Skin and muscle receptors in the leg and foot provide able-bodied humans with force and position information that is crucial for balance and movement control. In lower-limb amputees however, this vital information is either missing or incomplete. Amputees typically compensate for the loss of sensory information by relying on haptic feedback from the stump-socket interface. Unfortunately, this is not an adequate substitute. Areas of the stump that directly interface with the socket are also prone to painful irritation, which further degrades haptic feedback. The lack of somatosensory feedback from prosthetic legs causes several problems for lower-limb amputees. Previous studies have established that the lack of adequate sensory feedback from prosthetic limbs contributes to poor balance and abnormal gait kinematics. These improper gait kinematics can, in turn, lead to the development of musculoskeletal diseases. Finally, the absence of sensory information has been shown to lead to steeper learning curves and increased rehabilitation times, which hampers amputees from recovering from the trauma. In this study, a novel haptic feedback system for lower-limb amputees was develped, and studies were performed to verify that information presented was sufficiently accurate and precise in comparison to a Bertec 4060-NC force plate. The prototype device consisted of a sensorized insole, a belt-mounted microcontroller, and a linear array of four vibrotactile motors worn on the thigh. The prototype worked by calculating the center of pressure in the anteroposterior plane, and applying a time-discrete vibrotactile stimulus based on the location of the center of pressure.
ContributorsKaplan, Gabriel Benjamin (Author) / Abbas, James (Thesis director) / McDaniel, Troy (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05