Jan Perkins

Exercise During the Childbearing Year

Many women wish to continue to pursue an active life-style during pregnancy, while the pregnancy itself may provide the motivation for other more sedentary women to begin an exercise program for the sake of improved health/fitness. Also, female competitive athletes, upon becoming pregnant, may wish to continue sports performance and require careful monitoring to assure maternal-fetal safety. This review is designed to assist the perinatal educator who is in the position to advise the pregnant patient on the risks and benefits of physical activity during the childbearing year and provide suggestions for developing individualized exercise programs.

Effect of viewing angle on arm reaching while standing in a virtual environment: Potential for virtual rehabilitation

Functional arm movements, such as reaching while standing, are planned and executed according to our perception of body position in space and are relative to environmental objects. The angle under which the environment is observed is one component used in creating this perception. This suggests that manipulation of viewing angle may modulate whole body movement to affect performance. We tested this by comparing its effect on reaching in a virtually generated environment. Eleven young healthy individuals performed forward and lateral reaches in the virtual environment, presented on a flat screen in third-person perspective. Participants saw a computer-generated model (avatar) of themselves standing in a courtyard facing a semi-circular hedge with flowers. The image was presented in five different viewing angles ranging from seeing the avatar from behind (0 degrees), to viewing from overhead (90 degrees). Participants attempted to touch the furthest flower possible without losing balance or stepping. Kinematic data were collected to analyze endpoint displacement, arm-postural coordination and center of mass (COM) displacement. Results showed that reach distance was greatest with angular perspectives of approximately 45-77.5 degrees , which are larger than those used in analogous real world situations. Larger reaches were characterized by increased involvement of leg and trunk body segments, altered inter-segmental coordination, and decreased inter-segmental movement time lag. Thus a viewing angle can be a critical visuomotor variable modulating motor coordination of the whole body and related functional performance. These results can be used in designing virtual reality games, in ergonomic design, teleoperation training, and in designing virtual rehabilitation programs that re-train functional movement in vulnerable individuals.

Undergraduate Interdisciplinary Education: Are We Educating for Future Practice?

Interdisciplinary practice is encouraged and even mandated in many health care settings, however teams often do not live up to their potential. Interdisciplinary education pre-qualification is frequently recommended to prepare students for team practice after graduation. This paper describes a brief survey of interdisciplinary educational activities of occupational therapy and physiotherapy programmes in Canada. Questions were asked about current activities, anticipated changes, and the level of formal institutional support for interdisciplinary education. Results indicate that interdisciplinary activities are encouraged now and many programmes hope to expand in the future. The authors suggest that using a model to guide interdisciplinary experiences at the undergraduate level may be helpful in educating for future practice.

Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: A pilot study

Abstract Primary objective: The study objective was to test the efficacy of game-based virtual reality (VR) therapy as a mean of correcting postural and co-ordination abnormalities in individuals with traumatic brain injury (TBI). Therapy was done with interactive customized VR games and scenarios, utilizing an Xbox Kinect sensor. Research design: The study was a pilot project using the structure of a phase II clinical trial. Methods and procedures: Fifteen participants with mild-to-moderate chronic TBI-related balance and motor co-ordination impairments participated in 15 sessions, each lasting ∼50–55 minutes, scheduled 2–3 times a week over 5–6 consecutive weeks. Participants were evaluated at baseline, immediately after the final session and in a 1-month follow-up with a battery of clinical tests (measuring postural stability, gait and co-ordination) and movement performance parameters. Movement parameters included arm–leg co-ordination, dynamic stability and arm precision, calculated from kinematic data recorded with Xbox Kinect sensor. Results: Following therapy, most participants improved their static and dynamic postural stability, gait and arm movements. These effects persisted over the retention interval. Conclusions: Results will be used to improve the VR program, with the goal of producing a cost-effective, accessible and easy to individualize therapeutic approach. The pilot data will be used for designing a larger scale clinical trial.

Gaze and viewing angle influence visual stabilization of upright posture

Focusing gaze on a target helps stabilize upright posture. We investigated how this visual stabilization can be affected by observing a target presented under different gaze and viewing angles. In a series of 10‐second trials, participants (N= 20, 29.3 ± 9 years of age) stood on a force plate and fixed their gaze on a figure presented on a screen at a distance of 1 m. The figure changed position (gaze angle: eye level (0°), 25° up or down), vertical body orientation (viewing angle: at eye level but rotated 25° as if leaning toward or away from the participant), or both (gaze and viewing angle: 25° up or down with the rotation equivalent of a natural visual perspective). Amplitude of participants’ sagittal displacement, surface area, and angular position of the center of gravity (COG) were compared. Results showed decreased COG velocity and amplitude for up and down gaze angles. Changes in viewing angles resulted in altered body alignment and increased amplitude of COG displacement. No significant changes in postural stability were observed when both gaze and viewing angles were altered. Results suggest that both the gaze angle and viewing perspective may be essential variables of the visuomotor system modulating postural responses.

Physical therapy for correcting postural and coordination deficits in patients with mild-to-moderate traumatic brain injury

Abstract The purpose of this study was to test the effects of a conventional exercise program designed for correcting postural and coordination abnormalities in patients with mild-to-moderate traumatic brain injury (TBI). Using principles of motor learning applied to functional exercise training, exercises were performed while lying, sitting, standing and walking, with the goal of improving intra- and inter-limb coordination in the upper and lower extremities, postural stability and gait pattern. Twenty-two participants with TBI-related deficits received therapy in a supervised outpatient clinic. Therapy included 20 sessions, each approximately 55 to 60 min in duration, scheduled four to five times a week over four consecutive weeks. Each participant was evaluated with a battery of clinical tests at baseline and immediately after therapy. Upon completion of the therapy, participants improved static and dynamic postural stability and gait, evaluated with the Berg Balance Scale (from 45.2 ± 5.9 to 49.2 ± 4.2 points) and the Functional Gait Assessment (from 22.8 ± 4.1 to 26.9 ± 3.4 points). They also reduced truncal, upper and lower extremity ataxia, evaluated with the Ataxia Scale (from 7.3 ± 4.5 to 5.9 ± 4.2 points). Results will be used to refine the current version of the exercise therapy, which focused on whole body coordination and balance, and to design a large-scale clinical trial establishing effectiveness of this intervention and for comparison with other forms of therapy.

Challenging stability limits in old and young individuals with a functional reaching task

Objectives The aim of this study was to evaluate the extent to which adding a challenge to a reach test would increase the limit of stability (LOS) in young and old individuals. Design While standing on a force plate, with infrared markers on bony landmarks for motion analysis, 15 old (mean [SD], 70 [7] yrs old) and 15 young (mean [SD], 24 [2] yrs old) participants completed the modified functional reach test, in which they were asked to touch the farthest target possible in a series. They were then challenged to touch additional targets (functional reach challenge test) until they lost balance. Results The young participants reached farther than the old participants on both the modified functional reach and functional reach challenge tests (P = 0.005 and P = 0.003), but no group differences were found in absolute distance gains seen with the addition of the challenge. The participants in both groups displaced the center of pressure farther and used 10% more of their anatomic stability allowance in the functional reach challenge test than in the modified functional reach test. The young participants increased the LOS from 80.5% to 90.9% of their anatomic allowance, whereas the old participants increased theirs from 72.1% to 82.8%. Conclusions The challenge improved reaching and LOS similarly in the young and old participants, but the old participants used smaller absolute percentages of LOS. Knowing the flexibility of LOS is useful for rehabilitation practitioners in assessing balance and designing therapeutic exercises that challenge stability during performance of functional arm movements and train individuals to use their LOS safely.

Virtual reality game-based therapy for persons with TBI: A pilot study

The virtual reality (VR) therapy described below consists of a series of VR exercises, delivered with low-cost equipment. It replicates the conventional exercise and activity sequence recommended for restoring postural and coordination abnormalities after traumatic brain injuries (TBI). Efficacy was tested in a pilot group of 9 participants with TBI. They completed 15 sessions, each approximately 50 minutes duration. Most participants improved their postural stability, gait, and upper extremity movements. Exercise was done in a supervised environment to establish safety criteria. Results will be used to refine the current version of the therapy into a cost-effective, highly-accessible approach which can be delivered remotely via telerehabilitation.

Case Series Illustrating the Use of Consistent Rehabilitation Outcome Measures in Traumatic Brain Injury

Despite the prevalence of persons with traumatic brain injury (TBI), there is limited research evidence on rehabilitation outcomes for this population or therapy efficacy, making it difficult to document overall program outcomes. This may in part be due to the heterogeneity of the condition presentation, therapist and center treatment variability, and the expert recommendations for multidisciplinary care which complicates research design. A different approach may be to accept the heterogeneity of the population and gather consistent outcome data. A set of consistent measures used across the population may allow individual clinicians, managers and researchers to track therapy efficacy and over time improve management of this unique client population. This case series reports on the first three clients seen in one outpatient rehabilitation clinic where a consistent set of simple but clinically relevant physical rehabilitation outcome measures were added to therapy at evaluation and after every ten subsequent sessions. Measures selected were chosen to document key movement impairments and quality of life issues after TBI, yet be simple enough for use in routine clinical practice. Despite the considerable variation in client presentation (time since injury, age, clinical presentation) these measures were able to track improvement for each client. It is proposed that clinicians develop a standard battery of easily administered, functionally relevant outcome measures that can be used to study the effects of individualized therapies on this diverse population.

Virtual reality game-based therapy for restoring postural and coordination abnormalities in patients with TBI

Background: A traumatic brain injury (TBI) disrupts the central and executive mechanisms of motor coordination, involving abnormal postural control, arm(s) and postural (trunk and legs) interaction, difficulties with arms coupling, lack of agility, and movement precision. To address these issues, we developed the virtual reality (VR) therapy, which instead of regular exercises includes a series of immersive VR games and scenarios, delivered with low-cost equipment (Xbox Kinect, Microsoft Inc.). The therapy replicates the conventional exercise and activity sequence recommended for restoring postural and coordination abnormalities after TBI, and can be delivered either in a supervised Methods: Therapy efficacy was tested in 15 participants with moderate manifestations of TBI-related postural and coordination deficits, in the framework of phase II clinical trial. Therapy included 15 sessions, delivered in-clinic, each approximately 50-55 minutes in duration, scheduled 2-4 times a week over 5 consecutive weeks. Each participant was evaluated with a battery of clinical tests and movement performance parameters at baseline, immediately after the therapy; and 1 month after completion of the training.