Charles Merbitz

Hemiplegic gait : Relationships between walking speed and other temporal parameters

It has been asserted that speed alone is an effective indicator of the degree of gait abnormality. To determine the validity of this assertion, relationships between velocity and 18 other temporal gait parameters were determined in 25 patients with a first hemispheric stroke resulting in hemiplegia or hemiparesis of at least one month duration. Gait characteristics were recorded using footswitchs connected to a portable computerized monitoring device. Velocity was found to be significantly correlated with cadence, mean cycle duration, mean cycle length, hemiplegic limb stance phase duration, nonhemiplegic limb stance phase duration and percent, nonhemiplegic limb swing phase percent, double support phase duration and percent, hemiplegic limb swing/stance phase ratio, nonhemiplegic limb swing/stance phase ratio, and swing phase symmetry ratio but not with the hemiplegic limb stance phase percent, hemiplegic limb swing phase duration and percent, nonhemiplegic limb swing phase duration, stance phase symmetry ratio, and overall asymmetry ratio. Velocity is related to most, but not all, of the other temporal measures of hemiplegic gait. A comprehensive gait evaluation should also include characterization of the degree of asymmetry and descriptions of individual phase durations and proportions (particularly hemiplegic stance and swing percentages).

The timer-logger-communicator gait monitor: Recording temporal gait parameters using a portable computerized device

A portable microprocessor-based device, the timer-logger-communicator (TLC), was adapted and connected to footswitches to monitor and record temporal gait parameters in 25 hemiplegic and 30 normal subjects. Controls walked at 1.36 m/s with symmetric gait. Hemiplegic subjects had a mean walking speed of 0.43 m/s, asymmetric gait, and varying proportions of time spent in each phase, consistent with previously reported gait parameters. Trends in objective gait measures more closely paralleled trends in functional ambulation classification than in Brunnstrom motor recovery stages. The TLC gait monitor is a useful instrument to measure temporal parameters of gait in the clinical setting.

Wheelchair-based mobile measurement of behavior for pressure sore prevention

A recently developed device which provides continuous, direct monitoring of the pressure relief performance of persons confined to wheelchairs is reported. A custom portable computer records the data, which is transferred for analysis to an Apple IIe. The mobile computer can also signal the patient to relieve pressure on the basis of preset criteria and the patients performance. Teaching lift-offs to prevent ischial pressure sores is the object. Data collected with the device are used clinically and for research. Examples of such data are presented. The benefits of the device are reviewed.

Precision Teaching: Applications in Education and Beyond

Publisher Summary This chapter presents some of the innovations of Precision Teaching (PT) in more detail. It also describes the applications of PT for special education, college classrooms, prevocational training, accommodation to disability, personal growth, and other topics. The fast and convenient measurement, decision making, and communication of PT help teachers arrange the educational environment to benefit each learner as well as allow stakeholders to assess the celeration of each student. Students are by definition placed in special education classes when their performance is sufficiently below that of their age and grade mates. The content of an Individualized Education Programs (IEP) must include the childs current level of performance, measurable annual goals, short-term objectives, special education services, special education related services, supplementary aids, program modifications necessary for the child to make progress toward the goals, a plan for how progress toward the goals will be measured, and timelines for services. With that daily evaluation, PT facilitates the crucial function of driving these educational decisions with data. Programs are promptly changed if progress is insufficient, and programs are kept in place when progress is being made.

Cueing and logical problem solving in brain trauma rehabilitation: frequency patterns in clinician and patient behaviors

Frequencies (count per minute) of patient and therapist behaviors during rehabilitation sessions after traumatic brain injury were tracked in order to evaluate an intervention curriculum and the effects of cueing. Frequencies of correct solutions to logical problems and other verbal tasks during speech-language treatments were measured for an adult male with memory impairments and impulsivity who underwent inpatient rehabilitation 14 months after severe traumatic brain injury. Daily frequency of cues by the clinician during the patients logic exercises also was measured. These behaviors were recorded each treatment session for 14 weeks. Simple plots of the behavior frequencies were maintained by the clinician on standardized semi-log graph paper. The patients performance in solving logical problems improved measurably but gradually. Day-to-day predictability of patient performance was seen, as was predictability in cueing by the clinician. Celerations (trends measured as changes in count per minute per week) in the clinicians cueing were inversely related to celerations in the patients logical problem solving, a pattern evident through multiple reversals. Data from other verbal performance tasks showed no general improvement, nor any pattern of variability paralleling the data on logical problem solving. The data suggest that, for clients with brain trauma, routine continuous measurement of frequencies of behavior may facilitate clinical application of experimental analysis and intervention techniques to improve performance. Measuring the frequency of clinician behavior can help identify the events and conditions that control aspects of patient behavior. Frequency measurement has also been used in physical therapy and occupational therapy, and it is suggested that this method be examined as a common data language for use across rehabilitation disciplines. Copyright

Computerized behavioral-data collection and analysis for improved clinical outcomes in rehabilitation

Medical rehabilitation seeks change in patient behavior. Because of the variability in behavior across individuals and the uncertainty of clinical outcomes, an appropriate model for clinical intervention across the rehabilitation disciplines is single-case design. Therefore, the rehabilitation process can be facilitated by data collection and analysis tools similar to those used in the experimental analysis of behavior. We describe a system of computerized tools for the measurement and control of parts of this clinical process.

Precision Teaching: Foundations and Classroom Applications

Publisher Summary Precision Teaching (PT) is unique between approaches and methods of teaching and education. It has no fixed curriculum, subject-matter areas, types of students, or grade levels. It has been successfully applied with an incredible diversity of students, settings, and learning situations. People who do not practice data-driven decisions and instruction may have a difficult time understanding how precision teachers can verify whether a given curriculum is effective in their classrooms. School curricula typically are selected according to theoretical fads or political expediency, and data-driven evaluation of curricula is superior to those arbitrary processes. When first hearing about PT, many educators cannot imagine how they would operate such a truly individualized system with a whole class of students even if the students did their own charting. In a PT environment, the learner is neither pressured by comparisons to others who may be ahead nor embarrassed by unwelcome use as an example to others who may be behind.

Cueing and Logical Problem Solving in Brain Trauma Rehabilitation: Frequency Patterns in Clinician and Patient Behaviors

Frequencies (count per minute) of patient and therapist behaviors during rehabilitation sessions after traumatic brain injury were tracked in order to evaluate an intervention curriculum and the effects of cueing. Frequencies of correct solutions to logical problems and other verbal tasks during speech-language treatments were measured for an adult male with memory impairments and impulsivity who underwent inpatient rehabilitation 14 months after severe traumatic brain injury. Daily frequency of cues by the clinician during the patient’s logic exercises also was measured. These behaviors were recorded each treatment session for 14 weeks. Simple plots of the behavior frequencies were maintained by the clinician on standardized semi-log graph paper. The patient’s performance in solving logical problems improved measurably but gradually. Day-to-day predictability of patient performance was seen, as was predictability in cueing by the clinician. Celerations (trends measured as changes in count per minute per week) in the clinician’s cueing were inversely related to celerations in the patient’s logical problem solving, a pattern evident through multiple reversals. Data from other verbal performance tasks showed no general improvement, nor any pattern of variability paralleling the data on logical problem solving. The data suggest that, for clients with brain trauma, routine continuous measurement of frequencies of behavior may facilitate clinical application of experimental analysis and intervention techniques to improve performance. Measuring the frequency of clinician behavior can help identify the events and conditions that control aspects of patient behavior. Frequency measurement has also been used in physical therapy and occupational therapy, and it is suggested that this method be examined as a common data language for use across rehabilitation disciplines. Copyright

The Communication Analysis System

The Communication Analysis System (CAS) consists of data collection and analysis software that assists the clinician in providing effective and efficient rehabilitation treatment for persons with aphasia or language impairments after stroke or brain injury. It provides automated recording, filing, and graphing of functional communicative (behavioral) data so that the clinician and patient have objective, accurate, timely data displays with which to analyze the effects of intervention procedures. Thus treatment activities can be titrated for maximum progress. Therapy is better organized and managed and communication to families and other professionals is enhanced. Since the model provides absolute measures (like inches or meters) of behavioral function, the data are directly comparable across rehabilitation disciplines, functions and disabilities.<<ETX>>