Physiotherapy - Theses
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ItemActive video game technologies for balance rehabilitation after stroke( 2016)Standing balance deficits are frequent and disabling following stroke; however, optimal assessment and treatment for balance problems remains unclear. The past decade has seen the increasing emergence and clinical uptake of active video game technologies. The purpose of this thesis was to investigate the utility of active video games, in particular the Nintendo Wii, for balance rehabilitation following stroke. A comprehensive, narrative literature review of balance assessment and treatment following stroke was completed. Force platform technologies were found to provide a higher level of objective information on balance performance than clinical tests, but were inaccessible for most clinical settings. The Wii Balance Board (WBB) presented a valid and potentially feasible alternative; however, its clinimetric properties had not been investigated in a post-stroke sample. Active video games, such as the Wii Fit, demonstrated equivalence or superiority in efficacy to more traditional balance training approaches in emerging recent studies, but trials were generally small. Importantly, they provided little insights into feasibility, nor guidance in clinical implementation. A cross-sectional study was conducted to investigate the reliability, validity and feasibility of WBB-based tests of balance in an outpatient stroke setting. Thirty participants were tested on two occasions, one week apart. Five WBB-based standing balance tests demonstrated excellent test-retest reliability (ICC2,k = 0.82 to 0.98) and were poorly to moderately associated (r = 0.04 to 0.61) with performance in four clinical tests of balance and mobility. Minimal detectable change scores, floor and ceiling effects were investigated, to further inform the utility of the WBB variables. These tests were deemed feasible in terms of the time to complete and ease of use. A pilot randomised controlled trial was undertaken to investigate the feasibility and preliminary efficacy of a Wii Fit balance training program in an inpatient setting. Thirty participants (time since stroke, mean (SD) = 25 (18) days), randomised to Wii Fit balance or Wii Sports upper limb training, completed three Wii-based sessions per week over two or four weeks in addition to standard therapy. Feasibility of the Wii training was considered satisfactory based on adherence, acceptability and safety. Greater improvements in balance (i.e., the Step Test and WBB variables) were demonstrated by the Wii Fit balance group. Finally, a comprehensive, theory-based decision-making framework was developed for implementing active video game game-based balance training following stroke. It provides a resource to guide training decisions considering different aspects of the individual, task and environment, underpinned by motor learning theory. This framework may support future clinical and research applications of these technologies. This thesis found the WBB to be a reliable and potentially feasible force platform alternative for low-cost research and clinical use. Wii Fit training was found to be acceptable and safe in an inpatient stroke rehabilitation setting, and the efficacy results can inform the design of future trials. A decision-making framework for active video game implementation is proposed as a potentially valuable clinical resource to guide practice and future research. This thesis provides a substantial contribution to the knowledge in this field and may contribute to improved quality of stroke care in the future.
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ItemFeasibility, safety and efficacy of dance for people with Parkinson's disease: a pilot study( 2013)The purpose of this thesis is to investigate the safety, feasibility and efficacy of dance for people with Parkinson’s disease (PD). Parkinson’s disease is a progressive neurological condition that is characterised by slow gait, reduced movement amplitude, tremor, rigidity, postural instability and diminished health-related quality of life (HRQOL). Physiotherapy and therapeutic exercise aimed at improving gait and balance are argued to be an important component in the management of PD and have been shown to improve gait function, mobility, balance and HRQOL in some individuals. Given the progressive and long term nature of the disease, it is important for people with PD to have access to a wide variety of exercise options so that they can remain active. Recent reports indicate that dance is emerging as an alternative to traditional exercise programs for people with PD, however there is little information regarding the safety and feasibility of dance interventions. A systematic review and critical appraisal was conducted with the aim of identifying studies that provide reports of safety, feasibility, intervention delivery and the efficacy of dance interventions for people with PD. The identified studies were of low to moderate methodological quality and design and the reporting of safety and feasibility outcomes was inconsistent. Whilst attrition was well reported, it was challenging to conclude the level of adherence and the occurrence of adverse events during dance classes due to limited reporting of these outcomes. The level of supervision provided, provision of instructor training and advice and the selection of music and movement choices was also not well reported. The results of a between-group synthesis of balance and mobility data showed a trend towards improvement in these outcomes following a dance intervention when compared to controls. These findings present limited evidence to support the efficacy of dance for people with PD. A group of nine Australians living with mild to moderate PD participated in a pilot case-series study to determine the safety, feasibility and efficacy of a six-week contemporary dance program. Safety and feasibility outcomes evaluated included the occurrence of adverse events, attrition, adherence and participant satisfaction. The effect of the dance program on gait function, functional mobility, balance, balance and gait self-efficacy and HRQOL was examined prior to the intervention, immediately post-intervention and at three months. The contemporary dance program was found to be a feasible and safe activity for people with PD in terms of attrition, adherence and adverse events. Attrition was low, with eight and seven participants completing follow-up assessments at post intervention and three-months respectively. Adherence was high with participants completing 78% of all available dance classes. Significant improvements in gait hypokinesia were observed immediately post-intervention compared to baseline measures and continued to improve three-months later. Significant improvements in functional mobility, relative to baseline were seen at post-intervention with a trend toward improvement noted at three-months. Despite improvements in gait function, there was little to no change observed for measures of balance, gait and balance self-efficacy and HRQOL. These results provide evidence to further support the safety and feasibility of dance for people with mild to moderate PD, and support the need for large randomized controlled trials to determine the efficacy and outcomes of dance therapy. Participant satisfaction is commonly regarded as an important component of quality health care and may influence the successful implementation of new interventions into clinical practice. Two focus groups were conducted after the pilot study with the purpose of gaining insight into the experiences and attitudes of the contemporary dance participants and to explore participant satisfaction within the context of feasibility. Thematic analysis revealed that participants were satisfied with the intervention and considered contemporary dance to be an acceptable form of exercise. The focus groups also revealed that the participants had a strong emotional reaction to the dance classes and identified several emotional, physical and cognitive benefits. This thesis has provided further knowledge to suggest that dance is a safe and feasible exercise alternative for some people with mild to moderate PD. Furthermore, this thesis has provided new evidence to support the efficacy of a short duration contemporary dance program to improve aspects of physical function and HRQOL. Although future work is needed, this research provides clinicians with evidence that supports the implementation of dance into clinical practice where it can benefit individuals living with Parkinson’s disease.