Article 1
An application of the experience sampling method to the study of aphasia: A case report.
Authors:
Fitzgerald-DeJean, Donna M. ;Rubin, Scott S. ;Carson, Russell L.
Affiliation:
Department of Allied Health Services, Nicholls State University, USA
Department of Communications Disorders, Louisiana State University Health Sciences Center, USA
Department of Kinesiology, Louisiana State University, USA
Source:
Aphasiology (APHASIOLOGY), 2012 Feb; 26(2): 234-51
Publication Type:
journal article - research, tables/charts
Language:
English
Major Subjects:
Aphasia -- Therapy
Quality of Life
Aphasia -- Psychosocial Factors
Self Assessment
Life Experiences
Minor Subjects:
Human ;Self Report ;Aged ;Case Studies ;Summated Rating Scaling ;Male ;Neuropsychological Tests ;Language Tests ;Software ;Descriptive Statistics ;Pearson's Correlation Coefficient
Abstract:
Background: Researchers stress that functional health and psychological well-being are important aspects of quality of life in the investigation of individuals with aphasia. Employed in the social sciences, the experience sampling method (ESM) has begun to shed light on deviations in participants' momentary responses to behavioural contingencies in naturalistic environments. Applications of ESM have demonstrated value in monitoring within-participant variations in mood, psychopathology, and treatment outcomes while minimising the effect of memory bias. Additionally, the application of ESM in psychological cognitive-behavioural therapy and occupational therapy (OT) research reportedly appeared to contribute to treatment success. A time-based, fixed-schedule sampling application of ESM was used in this study to attain self-reports throughout an aphasia treatment programme. Aims: The current investigation introduced the ESM paradigm to the study of aphasia and piloted its use in measuring psychoemotional variables in an individual with chronic aphasia participating in an intensive treatment regime. Methods & Procedures: Repeated ESM probes were administered during a university-based treatment programme to measure the daily responses of a 75-year-old participant with a moderate-to-severe communicative impairment secondary to a cerebral vascular accident (CVA). A total of 20 brief ESM probes were cued by clinicians at four fixed times per day, 5 days a week during a 35-hour a week, 6-week programme. Probes conducted throughout each day used a 5-point Likert scale to query participant response to psychoemotional variables perceived happiness, perceived tiredness, perceived stress, and perceived communication satisfaction. Outcomes & Results: Findings revealed that the participant with aphasia was able to respond to a 5-point Likert scale administered with a personal data assistant (PDA) with 100% compliance when cued by clinicians that it was time to complete the ESM probe (464 responses across 29 days). The internal validity of internal states used in this study is supported by the strong negative correlation found with perceived happiness between both perceived tiredness (p < .01) and perceived stress (p < .01), as well as the positive correlation found between the negative states of perceived tiredness and perceived stress (p < .01). Conclusions: This initial success of ESM implementation in this case study of aphasia treatment suggests that further explorations are needed in the application of ESM in aphasia research.
Journal Subset:
Allied Health; Biomedical; Blind Peer Reviewed; Europe; Expert Peer Reviewed; Online/Print; Peer Reviewed; UK & Ireland
Special Interest:
Psychiatry/Psychology; Speech-Language Pathology/Audiology
Instrumentation:
Cognitive Linguistic Quick Test (CLQT) (Helm-Estabrooks)
Communication Activities of Daily Living-2 (CADL-2) (Holland et al)
American Speech-Language-Hearing Association Quality (ASHA QCLS) (Paul et al)
Aphasia Diagnostic Profile (ADP) (Helm-Estabrooks)
ISSN:
0268-7038
MEDLINE Info:
NLM UID: 8708531
Publisher Info:
URL:
Entry Date:
20120113
Revision Date:
20120113
DOI:
10.1080/02687038.2011.621208
Accession Number:
2011395998
Database:
CINAHL Plus with Full Text
Article 2
Are Spatiotemporal Gait Characteristics Reliable Outcome Measures in Children With Developmental Coordination Disorder?
Morrison, Stewart C. PhD; Ferrari, Jill PhD; Smillie, Sally BSc(Hons)
Author Information
School of Health, Sport and Bioscience (Drs Morrison and Ferrari), University of East London, London, England; Children's Therapy Service (Ms Smillie), Medway Community Healthcare CIC, Gillingham, Kent, England.
Stewart C. Morrison, PhD, School of Health, Sport and Bioscience, University of East London, Water Lane, London, E15 4LZ United Kingdom ().
Grant Support: This research was supported by a clinical research prize from Canonbury Healthcare.
The authors declare no conflicts of interest.
AbstractPurpose: To evaluate the reliability of spatiotemporal gait parameters used in the clinical evaluation of children with developmental coordination disorder (DCD).
Methods: Participants recruited were asked to ambulate across a 4.5-meter GAITRite walkway (CIR Systems, Inc, Havertown, Pennsylvania) at a self-selected walking speed. The spatiotemporal parameters recorded for both limbs were: velocity (cm/sec), stance phase duration (%), swing phase duration (%), stride length (cm), double support duration (%), and single support duration (%).
Results: Intraclass correlation coefficient values attained in this study ranged from 0.24 to 0.73, with good reliability achieved for one parameter (cadence = 0.73), and moderate reliability for step length (0.55–0.58), stride length (0.57–0.61), and double support duration (0.56–0.59).
Conclusion: The findings from this study indicate that the clinical evaluation of spatiotemporal gait parameters in children with DCD can yield reliable data for some parameters but further work on this is warranted.
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INTRODUCTION AND PURPOSE
Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by impairment in motor coordination 1 leading to poor balance, delayed developmental characteristics, and motor coordination deficits.2 Children with DCD are considered a heterogeneous group as the motor coordination deficits tend to vary between individuals 3 and consequently problems can arise when attempting to clinically evaluate the gait patterns of these children.
In a study looking at gait patterns in children with DCD (n = 7), Woodruff et al 4 reported greater variance in the gait pattern of children with DCD when compared to a normative gait database for children who were typically developing, particularly for percentage of gait cycle for opposite toe off, single stance, toe off, and step length. Gait data for the children with DCD was derived from analysis using a 3-camera VICON motion analysis system (Oxford Metrics Ltd) and, despite the limitations of the work, the researchers reported no systematic pattern to the differences in parameters. A later study evaluating gait parameters in a sample of children with DCD (n = 10) and age matched controls (n = 10) during treadmill walking reported differences in temporal gait parameters for the children with DCD.5 A shorter stride time (P < .05), decreased double support duration (P < .05), decreased swing phase duration (P < .05), a higher cadence (P < .05), and decreased stride length (P < .05) were reported. These findings add to the clinical picture such that children with DCD can be described as walking with smaller but faster steps to maintain speed while minimizing the time when balance can be compromised. A recent study designed to characterize gait complexity and variability through the use of 3-dimensional gait analysis and elliptical Fourier analysis concluded that there was greater complexity in the movement characteristics of the lower limb in children with DCD suggesting difficulty with limb control during gait.6
Spatial gait parameters (including stride length and step length) and temporal gait parameters (including double and single support duration, stance, and swing phase duration) offer useful clinical data for assessment of the child, determining treatment objective(s) and also in monitoring the efficacy of intervention. Gait patterns in children are known for their variability when compared to adults and also when compared across age groups as gait develops. Greater trial-to-trial variability of gait in children has been reported when comparisons were drawn to adults.7 Comparison between a sample of children (mean age = 6.8 years) and adults (mean age = 27.5 years) revealed lower reliability in the children for gait velocity (m/s), stride length (cm), step length (cm), cadence (steps/min), step width (mm), foot angle (°), stance phase (ms), double support (ms), and gait cycle time (ms) but not swing phase (ms).7 Greater variability in the gait pattern was also reported for the children and considered to be due to poorer postural control.
Further work on the reliability of gait reported variable levels of reliability for spatiotemporal gait parameters in a sample of 57 children, stratified across 3 age groups.8 Reliability reported in the study differed across the 3 age groups with no clear pattern to the gait variables other than velocity and cadence which maintained good reliability across the age span. In a study evaluating spatiotemporal gait parameters in children with motor disabilities (including cerebral palsy, Angelman syndrome, and arthrogryphosis), excellent reliability was reported for cadence, velocity, cycle time, base width, and stride length.9 To the authors' knowledge there have been no studies looking at the reliability of gait parameters in children with DCD. Because of the gait variability typically observed in children with DCD it is unclear as to what use the clinical evaluation of spatiotemporal parameters might serve as an atypical gait pattern makes it difficult for the clinician to monitor and objectively evaluate the efficacy of intervention and rehabilitation. Therefore, the aim of this study was to evaluate the intra-session reliability of spatiotemporal gait parameters used in the clinical evaluation of a sample of children with DCD.
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METHODS
The study sample was recruited from children entering a multidisciplinary therapy program for those diagnosed with DCD at the Sanderson Child Development Centre, Medway Maritime Hospital and ethical approval was granted by University of East London Ethics Committee and Lewisham Local Research Ethics Committee. All children aged between 6 and 11 years and referred with a diagnosis of DCD were identified as potential participants for the study. Following entry to the rehabilitation programme children were invited to participate. Children with additional medical complications likely to affect gait were excluded from the study and this included any condition affecting neuromuscular integrity and orthopedic conditions (such as talipesequinovarus) leading to a gait disorder. Any child wearing foot orthoses in their shoes were excluded from the study and all children had their feet and footwear screened by a podiatrist prior to inclusion. All children wearing Velcro or laced-up trainers/school shoes were invited to participate. Parents/guardians of all children suitable for inclusion were required to give written consent before being enrolled in the study. Children were also asked for assent prior to participation.
The GAITRite walkway was used for the collection of spatiotemporal gait parameters. The 4.5-meter mat was placed in the center of a walkway and each participant was instructed to walk across the mat to become comfortable with the procedure. Following this each participant was asked to ambulate across the mat and 3 trials were captured, with an average of 4 to 5 steps per trial. All children were instructed to walk in their normal style at a self-selected speed from approximately 2 meters before the mat and for 2 meters after the mat, while looking ahead at a point on the wall at the end of the room. Any footsteps that did not fall within the active sensor area of the mat were deleted and any trials with obvious disruption to the typical gait pattern were deleted and the trial recaptured. All trials were conducted in the footwear identified prior to participation in the study. Only trials deemed by the parents/guardians as accurately representing their child's normal gait were accepted and the parameters recorded were: velocity (cm/sec), stance phase duration (% of gait cycle), swing phase duration (% of gait cycle), stride length (cm), double support (% of gait cycle), and single support (% of gait cycle).
Data for both limbs were extracted for all participants and statistical analysis was conducted using SPSS Version 15 for Windows (SPSS Inc, Chicago, Illinois). Data were initially explored for normality with the Kolmogorov-Smirnov test. All gait parameters were uniform and normally distributed (P > .05). Reliability was assessed across 3 repeated trials collected on the same day and evaluated with intraclass correlation coefficients (ICC) (3,1). Absolute measures of reliability were evaluated using coefficients of variation (CV), an expression of the standard deviation as a proportion of the mean.10 The interpretation of the CV is independent of units of measurement but without defined boundary and there are no recognized thresholds for poor, moderate, or good variability in the data other than the higher the percentage scores the greater the variability in the data. ICC values were interpreted in accordance with Portney and Watkins 11 where values greater than 0.75 indicate good reliability, 0.5 to 0.75 moderate reliability, and values below 0.5 indicative of poor reliability. Systematic differences between the left and right limb (L limb and R limb, respectively) were evaluated with the paired t test with the level of significance set at 0.05. To satisfy clinical interest in the results, data from both limbs are presented.
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RESULTS
Twenty participants were recruited into the study; all were male with an age range of 6 to 11 years and a mean age of 7.5 years. Coefficients of variation are presented in Table 1 and demonstrate a range of values for the gait parameters ranging from 2.2% to 12.1%, with stance phase duration (L limb) demonstrating the lowest variation (2.7%) in measurement and double support duration (R limb) demonstrating the greatest (12.7%). / Table 1
As an index of reliability, the ICC was applied across a mean of 3 ratings values, presented in Table 1. Values ranged from 0.24 to 0.73 with good reliability achieved for one parameter (cadence = 0.73) and moderate reliability achieved for step length (right = 0.55 and left = 0.58), stride length (left = 0.57 and right = 0.61), and double support duration (left = 0.56 and right = 0.59). Poor and moderate reliability was found for swing phase duration (right = 0.32 and left = 0.57), and single support duration (left = 0.33 and right = 0.55), and poor reliability for velocity (0.24).
On comparison of gait parameters between left and right limb, significant differences were found for step length and single support duration (P <= .05) (Table 2).