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Biomedical subjects

Johanne Desrosiers

Publications and source records attributed to Johanne Desrosiers.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of long-term participation after stroke.

PURPOSE: (1) To explore factors that predict long-term participation after stroke (2-4 years after discharge from rehabilitation), and (2) to determine factors that predict both short- and long-term participation. METHODS: Biopsychosocial data of people who had had a stroke were measured at discharge from an intensive rehabilitation unit using valid instruments. Six months later (n=102) as well as 2-4 years later (n=66), social participation of the survivors was measured in their living environments. Participation was estimated with the Assessment of Life Habits (LIFE-H), which includes 12 categories of daily activities and social roles. RESULTS: From multivariate regression analyses, the best predictors of long-term participation after stroke appear to be age, comorbidity, motor coordination, upper extremity ability and affect. Age, comorbidity, affect and lower extremity coordination are the best predictors of participation after stroke at both measurement times. CONCLUSIONS: With the exception of age, these factors may be positively modified and thus warrant special attention in rehabilitation interventions.

Activities of Daily Living↗
PubMed2006

Non-pharmacological interventions for aggressive behavior in older adults living in long-term care facilities.

BACKGROUND: Aggressive behavior (AB) is common in institutional settings. It is an important issue because of its consequences on both the person manifesting such behaviors and their caregivers. Although there are numerous studies assessing non-pharmacologic strategies to manage AB in older adults, no extensive review of the literature is available. This review synthesizes the current knowledge on the effectiveness of non-pharmacological interventions in institutional settings. METHOD: Papers describing the assessment of a non-pharmacological intervention to manage AB in which participants were at least 60 years old and living in a long-term care facility were selected mainly by searching various databases. RESULTS: A total of 41 studies were identified and included in the review. These studies mainly use quasi-experimental designs and include less than 30 participants. Sixty-six percent (27/41) of the studies report either a statistically or behaviorally significant reduction of AB as a result of a non-pharmacological intervention. Staff training programs and environmental modifications appear to be the most effective strategies. CONCLUSION: Non-pharmacological interventions seem effective for managing AB. Future studies on the effectiveness of these interventions need to be more rigorous. Development in this field needs to be based on knowledge regarding the determinants of AB in older adults.

Aged↗
PubMed2006

Kinematic analysis of upper limbs and trunk movement during bilateral movement after stroke.

OBJECTIVE: To compare the kinematics of the upper limbs and trunk during unilateral and parallel bilateral tasks in subjects with hemiparesis and control subjects. DESIGN: Comparative study. SETTING: Geriatric center offering rehabilitation services. PARTICIPANTS: Convenience sample of 15 persons (age, 69.4 +/- 12.0 y; > or = 3 mo poststroke) recruited in a geriatric center with rehabilitation services, and 13 control persons (67.8 +/- 7.5 y) participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Unilateral and bilateral movements toward 1 or 2 targets located beyond arm's length and positioned in 3 directions. Angular changes of both upper limbs and trunk were characterized in the sagittal, frontal, and horizontal planes. RESULTS: During the bilateral task, the deficits of the kinematic joints of the paretic upper limb persisted in subjects with hemiparesis as compared with the corresponding upper limb in the control subjects (abduction shoulder: subjects with hemiparesis, 5.7 degrees +/- 5.3 degrees; control subjects, 0.7 degrees +/- 4.8 degrees; extension elbow: subjects with hemiparesis, 38.2 degrees +/- 14.2 degrees; control subjects, 52.8 degrees +/- 12.5 degrees) with a marked flexion of the trunk (subjects with hemiparesis, 33.7 degrees +/- 8.7 degrees; control subjects, 26.8 degrees +/- 5.8 degrees). The elbow extension of the nonparetic upper limb was reduced (subjects with hemiparesis, 41.0 degrees +/- 13.6 degrees; control subjects, 52.8 degrees +/- 12.5 degrees). CONCLUSIONS: The use of parallel bilateral reaching tasks and placing movements of the upper extremities in the subjects with hemiparesis contributed an increase in the trunk flexion rather than improve the motor performance of the paretic upper limb, especially with regard to increasing elbow extension.

Aged↗
PubMed2006

Adaptation and coping following a first stroke: a qualitative analysis of a phenomenological orientation.

Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.

Adaptation, Psychological↗
PubMed2006

Long-term changes in participation after stroke.

BACKGROUND AND PURPOSE: People who have had a stroke may have difficulty resuming some of their previous activities, which leads to a decline in their participation in daily activities and social roles. The purposes of this study were to compare participation 6 months (T1) and between 2 and 4 years (T2) after discharge from a rehabilitation unit and to verify if any changes were associated with changes in personal and environmental factors. METHOD: Participation of people who had had a stroke was measured at T1 and T2 with the Assessment of Life Habits. RESULTS: A significant reduction (p < .001) in participation in daily activities was observed, specifically in the following categories: nutrition, p < .001; fitness, p = .004; personal care, p < .001; and housing, p = .001. However, participation in social roles was maintained during this period (p = .10). The increased perception of technology as a facilitator (environmental factor) over time explained a part of the decline in participation (R2 = 0.13). CONCLUSION: Factors associated with the reduction in participation in daily activities should be further studied in order to prevent this decline.

Activities of Daily Living↗
PubMed2006

[Cognitive training interventions for normal aging, mild cognitive impairment and Alzheimer's].

BACKGROUND: In the past few years, occupational therapists have been increasingly working with geriatric clients and have used interventions focused on enhancing independance and quality of life. In this area of practice, the cognitive training intervention aimed more specifically at memory disorders, is a promising intervention for the area of aging and occupational therapy. PURPOSE: The aim of this literature review is to present an overview of the fundamentals, objectives and procedures of the cognitive training intervention used with the following populations: aging people presenting a memory disorder associated with normal aging with mild cognitive impairment or with Alzheimer's disease. PRACTICE IMPLICATIONS: A discussion on the cognitive management of memory is presented with respect to the cognitive characteristics of each of these clients.

Aging↗
PubMed2006

[Analysis of quality of life concept in the context of older adults with physical disabilities].

BACKGROUND: The ultimate goal of the occupational therapist is to enhance or maintain a client's quality of life. PURPOSE: It is difficult, however, to find an operational definition of this concept. This article presents the results of a concept analysis of quality of life in the context of older adults with physical disabilities. RESULTS: Quality of life is defined by a subjective evaluation of the life circumstances of an individual with respect to his/her values. The results indicate the importance of physical, psychological, social and spiritual well-being, the satisfaction with life and the accomplishment of meaningful occupations. A satisfying functional state, manifested by the presence of adapted behaviors and the feeling of control over one's life are also useful to consider. PRACTICE IMPLICATIONS: This definition suggests that occupational therapists should broaden the vision of their treatment objectives (beyond the realization of activities of daily living and instrumental activities of daily living) and offer some avenues for the enhancement of quality of life.

Activities of Daily Living↗
PubMed2005

Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities.

BACKGROUND: Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism. METHODS: The goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2,332). RESULTS: The same percentage of older adults displayed physical aggressive behaviour (21.2%) or verbal aggressive behaviour (21.5%), whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical) were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia. CONCLUSION: Cognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive impairment and avoiding the use of chemical or physical restraints.

Aged↗
PubMed2005

Disability-based classification system for older people in integrated long-term care services: the Iso-SMAF profiles.

This study was conducted to develop and evaluate a disability-based classification system for management of long-term care (LTC) needs in an integrated service delivery system. We collected cross-sectional data on 29 items of the Functional Autonomy Measurement System (SMAF) from a stratified multistage sampling of 1977 elderly people with disabilities living in different environments. Disability profiles were identified using statistical clustering techniques combined with advice form a panel of experts. Their clinical meaningfulness, stability, reproducibility, homogeneity, heterogeneity and predictive validity were evaluated. The Iso-SMAF classification consisted of 14 homogeneous disability profiles characterized by a gradual progression in the severity of disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) accompanied by predominant limitations either in mobility or mental functions. The profiles achieved a Kappa reproducibility coefficient of 0.67 through cross validation. A stable cluster structure emerged when the items were analyzed using different methods. They explained 82% of the variance in nursing care time, 80% of the variance in cost of nursing care (skilled and unskilled) and 57% of the variance in total costs including both formal and informal sources of LTC services. The conclusion recommends their use for planning, managing and predicting LTC service needs in an integrated care system.

Activities of Daily Living↗
PubMed2005

Validation of a new lower-extremity motor coordination test.

OBJECTIVE: To determine the test-retest reliability and construct validity of a new lower-extremity motor coordination test, the Lower Extremity MOtor COordination Test (LEMOCOT). DESIGN: To test reliability, subjects with impairments in at least 1 lower extremity were evaluated twice by the same evaluator. To test construct validity, the LEMOCOT scores obtained from subjects who had had a stroke were correlated with physical, functional, cognitive, and perceptual tests. SETTING: Geriatric day hospital and functional intensive rehabilitation unit. PARTICIPANTS: In the reliability test, 29 people (mean age, 69.6y; range, 28-87y); in the construct validity, 144 people who recently had had a stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: In addition to the LEMOCOT, the following measures were used for construct validity: the Fugl-Meyer Assessment (motor function), Berg Balance Scale, 5-m walking test, 2-minute walking test, Functional Autonomy Measurement System, Modified Mini-Mental State Examination, and Motor-Free Visual Perceptual Test. RESULTS: Intraclass correlation coefficients (ICCs) indicated that test-retest reliability is good (right-side ICC=.88; left-side ICC=.83). The construct validity of the LEMOCOT was demonstrated by obtaining high correlations with physical and functional tests ( r range, .62-.79; P <.001) and no correlations with cognitive ( r =.11, P =.20) or visual perceptual tests ( r =.15, P =.08) and by discriminating between subjects discharged to long-term care versus other living environments ( P <.001). CONCLUSIONS: The LEMOCOT is a simple lower-extremity motor coordination test that showed good test-retest reliability and construct validity. It can be used in clinical and research settings, specifically with people who have had a stroke. Other studies should be carried out to confirm its psychometric properties.

Adult↗
PubMed2005

Norms for 15- to 34-year-olds for different versions of the finger-to-nose test.

OBJECTIVES: To develop norms for the time to execute different versions of the finger-to-nose test (FNT) and to determine the effects of different testing procedures on performance in people aged 15 to 34 years. DESIGN: Cross-sectional. SETTING: Research center. PARTICIPANTS: Healthy subjects (149 men, 148 women; age range, 15-34 y) participated, and 36 men and 36 women were included in each of the 4 age categories studied (15-19 y, 20-24 y, 25-29 y, 30-34 y). Participants performed, in random order, 5 forms of the test in 2 positions (sitting, supine) with the right and left upper limbs (ULs). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Time (in seconds) to complete 5 cycles of movement. RESULTS: Test version and side of UL were found to affect performances; right-sided performances were faster than left-sided. Performances did not vary significantly (P>.001) with sex or among age categories; therefore, the results are presented for the group. Mean performances varied from 3.44 to 4.29 seconds. Subsequent analysis of variance (with data for each UL) showed main effects for testing position (sitting > lying) and eye condition (eyes open > eyes closed). Versions were strongly interrelated (.85<r<.98). CONCLUSIONS: Norms for the time to execute different FNT versions were developed for both ULs for healthy people ages 15 to 34 years.

Adolescent↗
PubMed2005

Weight-bearing on the lower limbs in a sitting position during bilateral movement of the upper limbs in post-stroke hemiparetic subjects.

OBJECTIVE: Verify weight-bearing on the feet in a sitting position during pointing in different directions with 1 or both upper limbs. DESIGN: Comparative study. SUBJECTS: Fifteen subjects with post-stroke hemiparesis with good to very good motor recovery and 13 healthy subjects participated in the study. METHODS: The subjects were seated on a chair with each foot resting on a force plate. They had to touch with 1 or, simultaneously with both hands, 2 target(s) located in front of them or at a 45 degrees angle on either side at a standardized distance beyond their upper limb's length. The percentage of weight loading variation under each foot was measured. RESULTS: Weight-bearing on the paretic foot is reduced during unilateral and bilateral pointing in the anterior direction and 45 degrees ipsilateral to the paretic side. However, both unilateral and bilateral pointing 45 degrees contralateral to the paretic side produced symmetrical weight-bearing on both feet, paretic and non-paretic. CONCLUSION: Since the paretic muscles of the trunk are probably used to control the leaning of the trunk towards the non-paretic side, the subjects with hemiparesis may put weight on the paretic foot to compensate for trunk weakness and maintain balance.

Aged↗
PubMed2005

Participation after stroke compared to normal aging.

OBJECTIVE: To examine the reduction in participation of people who have had a stroke compared with healthy people with normal aging. DESIGN: Participation of people who had a stroke was compared with participation of healthy subjects. SUBJECTS/PATIENTS: Forty-six people who had a stroke for 2-4 years and 46 healthy participants matched on age, sex and living environment. MEASUREMENTS: Participation was estimated with the Assessment of Life Habits (LIFE-H). The LIFE-H (short version 2.1) is composed of 58 daily activities and social roles associated to the 12 categories of the Disability Creation Process model. The LIFE-H gives separate scores for each category, for 2 main subsections "Daily activities" and "Social roles" and a total score. RESULTS: Scores of healthy subjects did not reach the maximum value (9/9) of the LIFE-H, their mean scores varying from 6.3 to 8.6, according to the categories. These scores are higher than of the participants with stroke for all categories (scores varying from 3.9 to 6.5; p-values from 0.002 to <0.001), except the interpersonal relationships category (score of 7.8 vs 8.0) where no difference was found (p=0.49). The disruption in participation after stroke varies according to the categories of the LIFE-H, but is more important in the daily activities categories. CONCLUSION: The comparison of the scores obtained by the 2 groups suggests that a part of the reduction in participation in daily activities and social roles after stroke is attributable to normal aging and not entirely to the stroke itself. It helps to focus interventions on activities and roles disruption domains that are really attributable to stroke.

Activities of Daily Living↗
PubMed2005

Reliability and construct validity studies of an obstacle course assessment of wheelchair user performance.

The objective of this study is to evaluate the reliability and construct validity of an obstacle course assessment of wheelchair user performance (OCAWUP). Seventeen experienced wheelchair users using three different propulsion methods (two hands, one hand and one foot or motorized wheelchair) were assessed twice on the 10 obstacles of the OCAWUP. To evaluate reliability, time (in seconds) and degree of ease (DE) in overcoming obstacles (four-level scale) were assessed by three occupational therapists. Construct validity was assessed by verifying whether the OCAWUP's global score of ease (GSE) varied with wheelchair propulsion methods and the functional independence measure (FIM). Intraclass correlation coefficients calculated for reliability of time and GSE were up to 0.74 for test-retest reliability and up to 0.97 for interrater reliability. Cohen's kappa coefficients calculated for DE reliabilities varied from 0.09 to 1.0 with degrees of association up to 65%. A significant difference (P<or =0.01) in GSE scores is shown between propulsion methods. A high significant correlation (rs=0.84, P< or =0.05) was found between GSE and scores of FIM items associated with mobility. Reliability of time and GSE is substantial or better. Reliability of DE is not as good, with a few items indicating poor reliability. OCAWUP's construct validity is good.

Acceleration↗
PubMed2005

Assembling a toolkit to measure geriatric rehabilitation outcomes.

OBJECTIVE: To gather and assemble relevant patient-based outcome measures with emphasis placed on the older adults' level of functioning and activity performance. DESIGN: The study was conducted in two phases. First, a set of relevant measurement instruments was identified, and their was value analyzed according to general characteristics and metrologic criteria. Second, this "toolkit" was pretested on 22 older adults with respect to the burden of assessment and the quality of the data. RESULTS: The toolkit includes eight measurement instruments related to mobility, basic activities of daily living, independent living, leisure, physical functioning, psychologic functioning, social functioning, and caregiver status. Participants' acceptance of the toolkit was high, with all subjects completing the toolkit in two sessions (30-90 mins each). The leisure participation and satisfaction measure was the most difficult to complete. Distributional properties were adequate to ascertain variability between subjects, except for a ceiling effect found for the social functioning measure. CONCLUSION: Measurement tools that are used in combination are needed to optimize the applicability and utility of outcome results. The toolkit has the potential to become a valuable method for researchers and clinicians reporting geriatric rehabilitation outcomes.

Activities of Daily Living↗
PubMed2005

Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of an arm training programme combining repetition of unilateral and symmetrical bilateral tasks for people in the subacute phase after stroke. DESIGN: Randomized controlled trial. SETTING: Inpatient functional rehabilitation unit. SUBJECTS: Forty-one people who had had a stroke, in the subacute phase, receiving conventional arm occupational and physical therapy, were randomized to an experimental group (n=20) and a control group (n=21). INTERVENTIONS: In addition to the usual arm therapy in the rehabilitation unit, the experimental group received an arm therapy programme (15-20 45-min sessions) based on repetition of unilateral and symmetrical bilateral tasks. The control group received additional usual arm therapy of a similar duration and frequency to the experimental treatment. MAIN MEASURES: The effect of the programme was judged on the basis of: (1) arm impairments (motor function, grip strength, gross and fine manual dexterity and motor co-ordination), (2) arm disabilities in tasks related to daily activities, and (3) functional independence in activities of daily living (ADL) and instrumental ADL (IADL). RESULTS: Although both experimental and control groups of participants improved similarly during the study period, the statistical analyses did not show any difference between the groups at the end of the treatment for the different dependent variables evaluated: (1) arm impairments: p = 0.43-0.79; (2) arm disabilities: p = 0.16-0.90; and (3) functional independence: p = 0.63 and 0.90. CONCLUSIONS: An arm training programme based on repetition of unilateral and symmetrical bilateral practice did not reduce impairment and disabilities nor improve functional outcomes in the subacute phase after stroke more than the usual therapy.

Activities of Daily Living↗
PubMed2005

[Heterogeneity of cognitive deficits in Alzheimer's and cognition therapy: research design ].

Numerous studies suggest that the clinical presentation of Alzheimer's disease (AD) is varied and that AD is thus a heterogeneous disorder. Evidence of this inter-individual variability has had an important impact on the approaches to the cognitive rehabilitation of AD, particularly in the early stages of the disease. Research has shown that, despite variable cognitive profiles, many preserved capabilities are observed in the first stages of AD and that the disease does not affect all cognitive functions globally. These preserved capabilities make it possible to apply cognitive interventions. However, numerous methodological difficulties are encountered in evaluating the effectiveness of these interventions, many of which are related to the heterogeneity of the deficits. The purpose of this article is to discuss this heterogeneity and its impact on methodological characteristics, especially participant selection and research design.

Alzheimer Disease↗