Debbie Hebert
Toronto Rehabilitation Institute
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Featured researches published by Debbie Hebert.
Archives of Physical Medicine and Rehabilitation | 2008
Robin E. Green; Brenda Colella; Debbie Hebert; Mark Bayley; Han Sol Kang; Christine Till; Georges Monette
OBJECTIVES (1) To examine predictive validity of global neuropsychological performance, and performance on timed tests (controlling for manual motor function) and untimed tests, including attention, memory, executive function, on return to productivity at 1 year after traumatic brain injury (TBI). (2) To compare predictive validity at 8 weeks versus 5 months postinjury. (3) To examine predictive validity of early degree of recovery (8wk-5mo postinjury) for return to productivity. DESIGN Longitudinal, within subjects. SETTING Inpatient neurorehabilitation and community. PARTICIPANTS Patients (N=63) with moderate to severe TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PRIMARY OUTCOME return to productivity at 1 year postinjury. Primary predictors: neuropsychological composite scores. Control variables: posttraumatic amnesia, acute care length of stay (LOS), Glasgow Coma Scale score, age, and estimated premorbid intelligence quotient. RESULTS Return to productivity was significantly correlated with global neuropsychological performance at 5 months postinjury (P<.05) and showed a trend toward significance at 8 weeks. Performance on the untimed composite score, and more specifically executive and memory functions, mirrored this pattern. Logical Memory performance significantly predicted return to productivity, but not other memory tests. Timed tests showed no significance or trend at either time point. Early degree of recovery did not predict return to productivity. Among control variables, only acute care LOS was predictive of return to productivity. CONCLUSIONS Findings validate utility of early neuropsychological assessment for predicting later return to productivity. They also provide more precise information regarding the optimal timing and test type: results support testing at 5 months postinjury on untimed tests (memory and executive function), but not simple attention or speed of mental processing. Findings are discussed with reference to previous literature.
International Journal of Stroke | 2016
Debbie Hebert; M. Patrice Lindsay; Amanda McIntyre; Adam Kirton; Peter Rumney; Stephen D. Bagg; Mark Bayley; Dar Dowlatshahi; Sean P. Dukelow; Maridee Garnhum; Ev Glasser; Mary-Lou Halabi; Ester Kang; Marilyn MacKay-Lyons; Rosemary Martino; Annie Rochette; Sarah Rowe; Nancy M. Salbach; Brenda Semenko; Bridget Stack; Luchie Swinton; Valentine Weber; Matthew Mayer; Sue Verrilli; Gabrielle deVeber; John Andersen; Karen Barlow; Caitlin Cassidy; Marie-Emmanuelle Dilenge; Darcy Fehlings
Stroke rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level. After a stroke, patients often continue to require rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication. Each year in Canada 62,000 people experience a stroke. Among stroke survivors, over 6500 individuals access in-patient stroke rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following stroke. These recommendations have been developed to address both the organization of stroke rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles). In addition, stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of stroke rehabilitation for children who have experienced a stroke, either prenatally, as a newborn, or during childhood. All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations. It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.
Canadian Journal of Occupational Therapy | 2006
Deborah Laliberte Rudman; Debbie Hebert; Denise Reid
Background. In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. Purpose. This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n=16) who use wheelchairs and their primary caregivers (n=15). Results. Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers. Practice Implications. In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.
Journal of Cancer Survivorship | 2014
Mary Stergiou-Kita; Alisa Grigorovich; Victrine Tseung; Elizabeth Milosevic; Debbie Hebert; Stephanie Phan; Jennifer M. Jones
PurposeTo review the empirical qualitative literature on cancer survivors’ experiences of the return to work process in order to develop strategies for health and vocational professionals to facilitate return to work.MethodsA rigorous systematic search of five databases was completed to identify relevant qualitative studies published between Jan 2000 and July 2013. All potentially relevant titles and abstracts were reviewed by two reviewers. For studies that met eligibility, the full-text articles were obtained and assessed for quality. The collected evidence was then synthesized using meta-ethnography methods.ResultsIn total, 39 studies met the eligibility criteria and passed the quality assessment. The synthesis of these studies demonstrated that cancer diagnosis and treatment represented a major change in individuals’ lives and often resulted in individuals having to leave full-time work, while undergoing treatment or participating in rehabilitation. Thus, many survivors wanted to return to some form of gainful or paid employment after treatment and rehabilitation. However, there was also evidence that the meaning of paid employment could change following cancer. Return to work was found to be a continuous process that involved planning and decision-making with respect to work readiness and symptom management throughout the process. Nine key factors were identified as relevant to work success. These include four related to the person (i.e., symptoms, work abilities, coping, motivation), three related to environmental supports (i.e., family, workplace, professionals), and two related to the occupation (i.e., type of work/demands, job flexibility). Finally, issues related to disclosure of one’s cancer status and cancer-related impairments were also found to be relevant to survivors’ return to work experiences.ConclusionsThis review reveals that cancer survivors experience challenges with maintaining employment and returning to work following cancer and may require the coordinated support of health and vocational professionals.Implications for Cancer SurvivorsCancer survivors need integrated support from health and vocational professionals (e.g., assistance with defining work goals, determining work readiness, determining how symptoms may impact work performance, suggesting workplace supports, and accommodations) to maintain and return to work after cancer diagnosis and treatment. These supports need to be provided throughout the recovery and rehabilitation process.
Journal of Neuroengineering and Rehabilitation | 2008
Paul Lam; Debbie Hebert; Jennifer Boger; Hervé Lacheray; Don Gardner; Jacob Apkarian; Alex Mihailidis
BackgroundIt has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1) an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2) an unobtrusive upper body postural sensing system; and 3) a vibratory elbow stimulation device to encourage muscle movement.MethodsA multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data.ResultsSeven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good) out of 4.0 (good). The postural sensors detected 93 of 96 (97%) therapist-simulated abnormal postures and correctly ignored 90 of 96 (94%) of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral) for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device.ConclusionAll eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as the prototype was considered to be generally well designed and capable of delivering reaching task therapy. The next stage of this project is to proceed to clinical trials with stroke patients.
Canadian Journal of Occupational Therapy | 2002
Denise Reid; Deborah Laliberte-Rudman; Debbie Hebert
The prescription of wheeled seated mobility devices for clients with mobility impairment is a growing area in occupational therapy practice. The goal is to enhance client participation in occupation through technical intervention. This critical review examines the body of knowledge concerning the impact and effectiveness of the provision of wheeled seated mobility on the occupational performance of wheelchair users and their caregivers. The scope and gaps in the literature are defined to identify areas for future research. While the focus is on the methodological issues of the research reports, the relevance of findings to occupational therapy practice will also be reviewed. The results of the 46 studies in this review indicate that the majority of research conducted thus far have methodological limitations, which limits the extent to which this body of research can be drawn upon to provide evidence for the effectiveness of wheeled mobility systems. While most of the studies reviewed addressed constructs of relevance to occupational therapy practice, there was an emphasis on performance components and inadequate attention to engagement in occupations. This review is an important first step in building the ability of occupational therapists to demonstrate effectiveness in wheeled seating interventions.
Paladyn | 2011
Elaine C. Lu; Rosalie H. Wang; Rajibul Huq; Don Gardner; Paul Karam; Karl Zabjek; Debbie Hebert; Jennifer Boger; Alex Mihailidis
Stroke is one of the major causes of permanent adult disability. Stroke frequently affects motor control of the arm, leading to diffculties in doing activities of daily living. This research focuses on developing an upper limb rehabilitation robotic prototype through user-centered design to aid stroke survivors in rehabilitating their arm. To gather requirements from end users, stroke therapy sessions were observed and a survey of stroke therapists was conducted. End user requirements were evaluated to determine technical targets for the mechanical design of the prototype. Evaluation of the prototype was done with stroke therapists in a focus group and a preliminary biomechanical study. As user-centered design would require more iterations of design, testing and evaluation, this project reports a first step in developing an affordable, portable device, which could increase access to stroke rehabilitation for the arm.
ieee international conference on rehabilitation robotics | 2011
Rajibul Huq; Patricia Kan; Robby Goetschalckx; Debbie Hebert; Jesse Hoey; Alex Mihailidis
This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a partially observable Markov decision process (POMDP) as its primary engine for decision-making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises. The performance of the system was evaluated through various simulations and by comparing the decisions made by the system with those of a human therapist for a single patient. In general, the simulations showed promising results and the therapist thought the system decisions were believable.
International Journal of Stroke | 2016
Colleen M. O’Connell; Norine Foley; Katherine Salter; Rhonda Booth; Rosemary Boyle; Donna Cheung; Nancy Cooper; Hélène Corriveau; Dar Dowlatshahi; Annie Dulude; Patti Flaherty; Ev Glasser; Gord Gubitz; Debbie Hebert; Jacquie Holzmann; Patrick Hurteau; Elise Lamy; Suzanne LeClaire; Taylor McMillan; Judy Murray; David Scarfone; Eric E. Smith; Vivian Shum; Kim Taylor; Trudy Taylor; Catherine Yanchula; Robert Teasell; Patrice Lindsay
Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. For patients, families and caregivers, this can be a difficult time of adjustment. The 2016 update of the Canadian Managing Transitions of Care following Stroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by clinicians who provide care to patients following stroke across a broad range of settings. The focus of these recommendations is on support, education and skills training for patients, families and caregivers; effective discharge planning; interprofessional communication; adaptation in resuming activities of daily living; and transition to long-term care for patients who are unable to return to or remain at home. Unlike other modules contained in the Canadian Stroke Best Practice Recommendations (such as acute inpatient care), many of these recommendations are based on consensus opinion, or evidence level C, highlighting the absence of conventional evidence (i.e. randomized controlled trials) in this area of stroke care. The quality of care transitions between stages and settings may have a direct impact on patient and family outcomes such as coping, readmissions and functional recovery. While many qualitative and non-controlled studies were reviewed, this gap in evidence combined with the fact that mortality from stoke is decreasing and more people are living with the effects of stroke, underscores the need to channel a portion of available research funds to recovery and adaptation following the acute phase of stroke.
ieee international conference on rehabilitation robotics | 2013
Rajibul Huq; Rosalie H. Wang; Elaine C. Lu; Debbie Hebert; Hervé Lacheray; Alex Mihailidis
This paper presents preliminary studies in developing a fuzzy logic based intelligent system for autonomous post-stroke upper-limb rehabilitation exercise. The intelligent system autonomously varies control parameters to generate different haptic effects on the robotic device. The robotic device is able to apply both resistive and assistive forces for guiding the patient during the exercise. The fuzzy logic based decision-making system estimates muscle fatigue of the patient using exercise performance and generates a combination of resistive and assistive forces so that the stroke survivor can exercise for longer durations with increasing control. The fuzzy logic based system is initially developed using a study with healthy subjects and preliminary results are also presented to validate the developed system with healthy subjects. The next stage of this work will collect data from stroke survivors for further development of the system.