RHSC Research Day 2016 Abstracts


Presentation Block 1

Feasibility of current exercise prescription during Anthracycline chemotherapy for breast cancer

Sarah Sayyari
BACKGROUND: Exercise during chemotherapy is both safe and effective for cancer patients. Given the benefits of exercise, there is justification for determining which exercise prescription is most appropriate for cancer patients. The ACSM exercise prescription recommends that cancer patients participate in 150 minutes of moderate activity per week. However, Jones, Eves, and Peppercorn suggest that this prescription may be unreasonable for many patients undergoing chemotherapy, and instead recommend 90 minutes of moderate activity per week, making progressions when appropriate.
METHODS: Participants enrolled in a supervised exercise program within the first half of their chemotherapy treatment. The progressive prescription included 3 weekly aerobic training sessions (20-30 min at 50-70% of heart rate reserve).  Criteria for determining feasibility included: attendance; adherence to prescribed intensity and duration; and participant retention. Staff collected reasons for failure to achieve the prescribed workout.
RESULTS: Sixty-four participants (age, 49±9 years, BMI, 26.3±5.9 kg/m2) enrolled. The intervention was a mean of 8.5±2.5 weeks.  The retention rate was 78%.  Mean attendance for all participants was 59±30%, and 72±19% with withdrawals excluded. Fifty five percent of participants adhered to the prescribed intensity at least 80% of the time, and 73% of participants adhered to the prescribed duration at least 80% of the time.  The total adherence to prescribed frequency, intensity, and duration combined was 44±27%. The most common reason for failing to meet the prescribed frequency, intensity, or duration was due to treatment symptoms.
CONCLUSIONS: The current exercise prescription for cancer patients appear not to be feasible for most women undergoing AC chemotherapy for early stage breast cancer. The dose of exercise that was performed may not be adequate to achieve cardio-protection and the current guidelines may need to be altered for those undergoing chemotherapy treatment.

No Longer Silenced and Misrepresented: Participatory and Emancipatory Research

Laura Yvonne Bulk

Introduction: Marginalization is systematic exclusion from meaningful participation, leading to denied opportunities. Despite inclusive rhetoric, disabled people face barriers leading them to be less likely to participate. This inequity is especially pronounced in the Health and Human Service (HHS) sector, where there exists a tension between promoting inclusion and maintaining professional competencies.
Methods: Through in-depth interviews we explored the perspectives of HHS students, clinicians, faculty, staff, and registrars regarding barriers and facilitators related to inclusion. Verbatim transcripts were analysed by the team using a constant comparative approach.
Results: Marginalization is a major barrier experienced by disabled people in HHS professions. Three mechanisms marginalize disabled people in HHS education and professions: 1) dominant disabling discourses, 2) discriminatory design within programs and universities, and 3) oppressive interactions.
Conclusions: The inclusion of disabled individuals is vital for ensuring HHS professionals represent the populations they serve. By challenging the views of educators, professionals, and scholars, these findings may be part of the foundation upon which change can be created.

Assessing the determinants of the healthy life style profile of stroke survivors

Beena Parappilly

Background: Research studies have attempted to establish the effectiveness of secondary prevention programs for stroke, yet the recurrence rate of stroke remains high. The knowledge level about stroke prevention varies among stroke survivors. Additionally, the adherence of stroke survivors to medications and other risk factor modification strategies have been less than optimal. Therefore, the objectives of this study are to: 1) determine the knowledge of risk factors, symptoms of stroke and knowledge of healthy behaviours among stroke survivors, 2) determine the lifestyle profile of stroke survivors (e.g., diet, physical activity, cholesterol, blood pressure), and 3) quantify the association of the level of knowledge, degree of participation in prior stroke prevention programs and other demographics (e.g., age, gender, education, income, primary/secondary stroke) on the healthy lifestyle profile after stroke.

Design: This is a prospective cross-sectional study of patients in a stroke unit within 48-72 hours of their admission with diagnoses of either primary or secondary stroke before they receive any formal stroke education.

Setting & Participants: The data will be collected from 80 patients recovering from stroke and admitted to St. Paul’s Hospital and Vancouver General Hospital.
Hypothesis: It is hypothesized that knowledge level and participation in stroke prevention programs as well as specific demographics (age, gender, living status, education, income, primary/secondary stroke) will be associated with the lifestyle profile of stroke survivors.
Main Outcome Measures: The data includes socio-demographic and disease specific data, knowledge level about stroke prevention, and healthy lifestyle profiles.
Data Analysis: Multiple regression analyses will be conducted to explore the association between knowledge of risk factors and healthy life style profiles.
Expected results: It is possible that those who had multiple strokes have improved their knowledge levels by virtue of them attending stroke or any chronic disease management programs or through their interactions with multiple healthcare professionals.
Conclusions: The data may expose the differences in knowledge levels among stroke survivors. This information will direct administrators and policy makers to the gaps in the secondary prevention programs. The identification of gaps will facilitate the development of new and novel interventions in the future.

Examining the design of accessibility information applications that serve people with disabilities

Mike Prescott

Introduction: Accessibility information is important for identifying barriers in the community that limit the participation of people with disabilities (PwDs). To benefit PwDs and those that shape the structure of the built and natural environment, accessibility information must be useful (provide breadth, depth, and be applicable to the person and context) and reliable (accurate and current). The purpose of this study is to examine how web and mobile applications have been developed to collect and disseminate useful and reliable accessibility information.
Methods: The first step identified accessible information applications by searching Google, iTunes and Google Play store. The second step refined eligible applications to those offered in English, focused on accessibility for PwDs, crowdsourced, and scalable beyond a single location or purpose (n=11). The final step was to extract and evaluate the features, attributes, and methods for assessing venues.
Results: Overall, applications provided limited depth and breadth. As a result, being able to apply this information to a PwD at a specific venue would be difficult. Information reliability was also limited by the use of ambiguous and subjective criteria that failed to illustrate how features were connected to each other.
Conclusions: Clearly, accessibility information provision is in its early stages and the applications reviewed are struggling to find a feasible approach for providing useful and reliable data.

Vibration attention task alters sensorimotor organization in individuals with chronic stroke

Kate Brown

Motor and somatosensory deficits persist well into the chronic phase of recovery in the majority of individuals with stroke. Impairments in sensorimotor integration may underlie these deficits and thus contribute further to poor motor function. In healthy individuals, a vibration attention task (VAT) modulates sensorimotor integration and benefits motor learning. The current work established baseline values on a battery of neurophysiological measures reflective of sensorimotor integration, and investigated whether a VAT could be utilized to alter sensorimotor integration in individuals with stroke. It was hypothesized that the VAT would induce changes in sensorimotor integration to a lesser extent post-stroke than seen in age-matched controls.
Eighteen individuals in the chronic phase of stroke recovery and eight age-matched controls participated in two experimental sessions. In the first session, sensorimotor integration was assessed using a sensorimotor organization (SMO) paradigm (Rosenkranz and Rothwell, 2003). Single-pulse TMS, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were collected over the ipsilesional primary motor cortex with and without concurrent vibration applied to the paretic abductor pollicis brevis (APB) muscle to assess the influence of afferent feedback on motor cortical excitability. In the second session, individuals performed a VAT (Rosenkranz and Rothwell 2012). The task consisted of cyclic vibration (2 seconds on, 2 seconds off) applied over the paretic APB. To direct attention to vibration during task performance, individuals were instructed to detect changes in the vibratory frequency and respond. Following completion of the task, the neurophysiological measures collected in the first session were repeated.
For each variable, a ratio was calculated to quantify the influence of concurrent vibration (ex. SMOICF/ICF). No significant differences were present at baseline in the neurophysiological measures assessed. However, following the VAT, individuals with stroke had an increase SMO ICF while age-matched controls presented with a reduction in the same facilitation.
This preliminary work indicates that sensorimotor integration remains plastic in individuals with chronic stroke. This suggests that modulation of sensorimotor integration should be investigated as a potential addition to neurorehabilitative strategies designed to improve sensorimotor function post-stroke.

Comparison of strength gains during and post adjuvant breast cancer treatment

Holly Wollmann

Introduction: Breast cancer treatment often results in a decline in muscular strength and physical function. Exercise is a potential mode of therapy to combat these losses. However research is needed into the most effective exercise prescription to use during adjuvant treatment.
Methods: Women with early stage breast cancer participated in a free, thrice-weekly exercise program during adjuvant treatment, and 20 weeks post treatment. The resistance prescription consisted of seven exercises performed for two sets of 10-12 repetitions, and progressed every two weeks. An estimated 1-RM test was performed at baseline, end of treatment, and 20 weeks post treatment to assess upper and lower body strength. A total of 33 women (50.8 ±9.1yrs) who completed all testing were used in this analysis from the larger cohort.
Results: Paired samples t-tests were used to compare the changes in 1-RM strength scores (kg.) in both chest press and leg press between time points. Both upper and lower body strength improved from baseline to end of treatment (endtx) (chest: 23.2 ±8.2 to 30.77±11.3 p=0.00; leg: 92.5±23.1 to 109.8±29.6, p=0.00). There were improvements from endtx to end of study (35.5±9.9, p=0.00; 121.1±24.7, p=0.00, respectively.)
Conclusion: Combined resistance and aerobic training during adjuvant treatment for breast cancer resulted in improvements in upper and lower body strength during both adjuvant treatment and post treatment.

Presentation Block 2

 Quality Indicators for Pulmonary Rehabilitation Programs in Canada

Waldo Cheung

Pulmonary rehabilitation (PR) is a comprehensive intervention of education, self-management, and exercise that improves quality of life, and symptoms of breathlessness in patients living with chronic respiratory diseases such as chronic obstructive pulmonary disorder, and interstitial lung disease. However, despite the proven benefit of this intervention, there remains a challenge in translating PR from the research laboratory to clinical practice. A recent multinational survey found notable inconsistencies in the organization and delivery of PR programs. These included inconsistencies in the organization of health care professionals, setting of PR, reporting of outcomes, and use of outcome measures. These inconsistencies are concerning as they are areas in PR that are linked to the quality and effectiveness of the programs. To find which specific areas in PR need improvement, a tool must first be designed to assess the quality of a PR program. Quality indicators (QIs) are a checklist of statements that can potentially identify specific areas of a PR program that need improvement. Currently there are no quality indicators developed for PR programs in Canada and we believe that existing QIs developed for PR programs in Spain and the United Kingdom do not address some of the components of PR in Canada. Therefore, we ask the question: “What are the quality indicators in PR programs across Canada”? Using a modified RAND Appropriateness Method (RAM), the objective of this study is to finalize a list of QIs that can be used for future pilot testing for external audits of PR programs in Canada. First, a list of QIs will be generated from a previously-conducted scoping review. Then a panel comprising of fourteen PR healthcare professionals and academics from the Canadian Respiratory Health Professionals and the Canadian Thoracic Society will be created. Using Survey MonkeyTM, an online survey software, the panel will rate each QI’s importance, validity and explicitness of evidence base, reliability, and feasibility on a 9 point Likert scale. Analysis of each QI’s consensus will be based on its median score and the inter-percentile-range-adjusted-for-symmetry and inter-percentile range (IPR-IPRAS) score. Consensus will be reached if a QI has a median score between 7 to 9 on a Likert Scale and an IPRAS-IPR score > 0. A final list of QIs that meet consensus for all the listed criteria will be created for future pilot testing of external audits.

The immediate and one month effect of lateral wedge insole in early knee osteoarthritis

Elham Esfandiari

Introduction: Osteoarthritis of the knee joint leads to clinical symptoms associated with declining performance and poor quality of life. Lateral wedge insoles are widely used as the conservative treatments at the early stage of the disease. The study aimed to evaluate pain, physical function, quality of life, and risk of falling in early KOA patients and also assess the immediate and one month therapeutic effect of lateral wedge insoles.

Methods: Persian version of Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee related quality of life subscale of Knee Injury and Osteoarthritis Outcome Score (KOOS) were filled by 20 patients with early knee osteoarthritis and 19 healthy matched controls. Fall risk was assessed by using two validate clinical instrument, the Timed Up and Go (TUG) test and clinical static one-leg balance (OLB) test. Immediate effect of 5º lateral wedge insole was considered for all participants. Patients with early knee osteoarthritis used the insoles for one month and reevaluated at the follow-up session.
Results: Patients showed significantly higher scores in pain, stiffness, and physical function subscales of WOMAC (P-value<0.001) and also lower score in knee related QOL subscale of KOOS (P-value<0.001), compared with healthy control group. Moreover, there was significant difference in time of OLB test and TUG test between knee osteoarthritis group at baseline and healthy control group (P-value<0.001). At baseline, the significance effect of lateral wedge insole on pain scales were observed (P-value<0.001) but there was no significant immediate effect between three conditions in each group (P-value>0.05). Furthermore, there is significant reduction in all clinical symptoms after one month usage except for stiffness (P-value=0.08). Conclusion: This study has demonstrated the worse clinical symptoms and risk of falling at the early stage of the knee osteoarthritis. Use of 5º lateral wedge insole with shock absorbing feature and mild medial longitudinal arch support in routine shoes for 5 to 10 hours a day, was recommended at early stage of the knee osteoarthritis.

A single session of priming exercise enhances visuomotor performance of Trail Making Test Part B but not Part A.

Bea Francisco

There is increasing interest in the use of acute exercise to enhance cognition, learning, and memory. A single session of priming exercise has been shown to influence motor cortex excitability, motor skill acquisition and motor learning. Our aim was to determine if an acute bout of priming exercise would influence visuomotor performance on a robotic version of the neuropsychological test, the Trail Making Test (TMT). We hypothesized that an acute bout of exercise would enhance performance on Part B, but not Part A, of the TMT due to the increased executive functioning demands of Part B. Thirteen young, healthy individuals completed two sessions examining the influence of an acute bout of high-intensity cycling on visuomotor performance of the TMT compared to a resting condition. In Session 1, performance on the TMT was evaluated immediately prior to and immediately post an exercise bout. The 20 min exercise bout consisted of a 5 min warm up, followed by 3 sets of 3 min high-intensity (90% max power output) interspersed with 2 min of low-intensity (50W) cycling. In Session 2, performances on the TMT Parts A and B were evaluated immediately prior to and immediately post a 20 min seated rest condition. The order of conditions was counterbalanced and the sessions were separated by a minimum 2-week washout period to minimize learning effects. There were no significant differences between baseline measures of Sessions 1 and 2, indicating there were no learning effects between the two sessions. A 2-way repeated-measures ANOVA with dwell time (s) as the dependent variable revealed that there was a main effect of time (F(1,12)=33.2, p < .001) and a condition by time interaction (F(1,12)=8.601, p = .13) for Part B. Post Hoc analysis revealed that there were significant decreases in dwell time from pre to post in both exercise (p<.001) and rest (p=.018) conditions. Change score (dwell time post – dwell time pre) as the dependent measure revealed that the exercise condition showed greater reductions as compared to rest (p=.013). There was no effect of exercise on any of the other measures for Parts A or B. These preliminary findings suggest that a single session of lower-limb “priming” exercise may influence visuomotor performance of the upper limb on tasks that require greater executive functioning. This work may have implications for neurorehabilitation approaches designed to use exercise to “prime” the central nervous system for optimizing performance and learning.

Using admission Berg Balance Scale score to predict improvement in walking ability during inpatient stroke rehabilitation

Dennis Riley Louie

Objectives: While the most improvement in walking ability occurs in the first few months after stroke, few studies have focused on the predictors of this early walking recovery. The objectives of this study were to identify baseline predictors of walking improvement during inpatient rehabilitation in the first months after stroke and to establish cut-off scores in the Berg Balance Scale (BBS) to predict the extent of walking improvement.

Methods:This cohort study utilized data collected from stroke patients on admission (two to three weeks post-stroke) to inpatient rehabilitation and at follow-up (four weeks later near discharge, approximately seven weeks post-stroke) from five hospitals. Baseline characteristics and outcomes (mental and physical function) were assessed. Multivariate logistic regression models were used to identify predictors of regaining independent ambulation, as well as community ambulation (gait speed  0.8 m/s) at follow-up. Receiver operating characteristic curve analysis was used to identify cut-offs for admission BBS scores to predict walking improvement.
Results: Baseline Mini Mental State Examination (Odds Ratio=1.44, 95%CI:1.05-1.98) and BBS (OR=1.07, 95%CI:1.01-1.14) scores were identified as predictors of community ambulation (n=123) after four weeks of inpatient rehabilitation. Baseline BBS was a predictor for regaining independent ambulation (n=84, OR=1.08, 95%CI: 1.03-1.14). A cut-off BBS score of 29 on admission predicts that an individual will go on to become a community ambulator (n=123, Area Under the Curve=0.88, 95%CI: 0.81-0.95), whereas a cut-off score of 12 predicts a non-ambulator to regain independent ambulation (n=84, AUC=0.73, 95%CI: 0.62-0.84).
Conclusions: An individual with a BBS score of 29 or greater at admission to inpatient stroke rehabilitation is highly likely to achieve a walking speed suitable for community ambulation. Individuals who score 12 or greater are likely to regain independent walking. Cognitive status at admission also predicts walking ability, and should therefore be considered by clinicians in discharge planning.

“We are not anything alike”: Marginalization of health professionals with disabilities

Laura Yvonne Bulk

Introduction: Marginalization is systematic exclusion from meaningful participation, leading to denied opportunities. Despite inclusive rhetoric, disabled people face barriers leading them to be less likely to participate. This inequity is especially pronounced in the Health and Human Service (HHS) sector, where there exists a tension between promoting inclusion and maintaining professional competencies.

Methods: Through in-depth interviews we explored the perspectives of HHS students, clinicians, faculty, staff, and registrars regarding barriers and facilitators related to inclusion. Verbatim transcripts were analysed by the team using a constant comparative approach.
Results: Marginalization is a major barrier experienced by disabled people in HHS professions. Three mechanisms marginalize disabled people in HHS education and professions: 1) dominant disabling discourses, 2) discriminatory design within programs and universities, and 3) oppressive interactions.
Conclusions: The inclusion of disabled individuals is vital for ensuring HHS professionals represent the populations they serve. By challenging the views of educators, professionals, and scholars, these findings may be part of the foundation upon which change can be created.

Presentation Block 3: Winners of “Best Abstract” award

 Examining Relationships of Physical Activity and Sedentary Behaviour with Cognitive Function among Older Adults with Mild Cognitive Impairment: A cross-sectional study

Ryan S. Falck

Introduction: Mild cognitive impairment (MCI) represents a transition between normal cognitive aging and dementia, and is a critical window to promote cognitive health through behavioural strategies. Current evidence suggests physical activity (PA) and sedentary behaviour (SB) are important for successful cognitive aging. However, we currently do not have a comprehensive understanding of PA and SB differences between individuals with MCI and those without MCI. Underlying differences due to cognitive status may also moderate the relationships of PA and SB with cognitive performance. Thus, we aimed to: 1) compare PA and SB characteristics based on MCI status (yes/no); and 2) determine if associations between PA and SB with cognitive performance differed based on MCI status.

Methods: We measured PA and SB of adults aged 55+ using the MotionWatch8©. Using the Montreal Cognitive Assessment (MoCA), we categorized individuals with MCI (<26/30) and without MCI (≥26/30). Global cognitive function was indexed by the Alzheimer’s Disease Assessment Scale-Plus (ADAS-Cog Plus). We compared PA and SB based on MCI status, and performed linear regression analyses to examine relationships of ADAS-Cog Plus with PA and SB based on MCI status.
Results: Those with MCI (n=83) had lower PA (p<0.01) and higher SB (p=0.03) levels compared with the no-MCI (n=69) group. Higher PA (β=-0.022, p=0.02) and lower SB (β=0.012, p=0.04) were associated with better ADAS-Cog Plus performance in the non-MCI group, but not in the MCI group.
Conclusions: Older adults with MCI have lower PA and higher SB than their non-MCI counterparts. Our results also suggest that future studies are needed to determine whether there is a minimum amount of PA required to elicit cognitive benefits in older adults with and without MCI.

Level of attention during motor planning of stepping indexed by gating of the N40 in healthy individuals.

Sue Peters

Introduction: Gating of task-relevant sensory stimuli occurs for the arm during motor planning, with reduced amplitudes of somatosensory evoked potentials (SEPs). Gating of SEPs also occurs during planning of plantarflexion with reduced N40 amplitudes in the leg region of the primary somatosensory cortex (Area 3b), in response to cutaneous stimulation. Animal work suggests that attention affects somatosensory cortical processing through supressed neural firing rates or gating. It is unknown whether attentional demands during planning in the leg also produce gating in humans. The aim of this study is to explore the influence of attention during planning of plantarflexion in healthy individuals.
Methods: On two separate days, neurophysiological data (Day 1) and a standardized attention test (Day 2) were collected in young, healthy individuals (4 f, 4 m; 29.1±4.6 yrs). On Day 1, electroencephalography (EEG) recorded SEPs over the Cz electrode elicited by tibial nerve stimulation. Three conditions were tested bilaterally: 1) Control, or no attentional demands, 2) Attention Toward the stimulated limb, and 3) Attention Away from the stimulated limb. Attention was directed Toward or Away from the stimulated limb with vibration (80 Hz) applied to the medial soleus at random 4-8 s intervals as the cue to plantarflex. On Day 2, global attention was assessed with the Integrated Visual Auditory test (IVA). To measure the N40, peak-to-peak amplitude of the P30/N40 was averaged for each condition. A 2-way ANOVA was performed with factors of leg (Right, Left) and condition (Control, Toward, Away) with post-hoc tests. Pearson’s correlations were run between the IVA and N40 amplitudes.
Results: There was a significant main effect of Condition for the N40 amplitude (p=0.025) indicating that attention during motor planning is reduced relative to the Control. Post-hoc tests indicated that the N40 amplitude was lower for the Toward condition than Control (p=0.019), but was not different for Away.  IVA scores correlated with the N40 amplitudes during the Toward condition for both limbs (Right r=-0.885, p=0.008; Left r=-0.784, p=0.021).
Conclusions: The N40 amplitude may index level of attention toward the leg during planning. The SEP is gated during planning the Toward condition, which may indicate that paying attention to plan a leg movement reduces the level of stimulus that reaches the cortex. This may have implications for somatosensory rehabilitation of the lower limb.

Physiological markers of dyspnoea: can surface electromyography be used?

Reid Mitchell

Exertional dyspnoea is a debilitating symptom that has a significant impact on exercise tolerance and quality of life in patients suffering from chronic respiratory diseases.  Recent evidence suggests that crural diaphragm electromyography (EMGdi) may be used as a physiological marker of exertional dyspnoea in humans.  However, this technique is invasive, technically demanding, and unlikely to be used in the clinical setting.  Surface EMG of the parasternal intercostal muscle (sEMGpara) has been proposed to be a non-invasive alternative to EMGdi during cycle exercise.  However, it is unclear if the sEMGpara signal is contaminated by EMG activity of the pectoralis muscles during cycle exercise.  Accordingly, the purpose of this study was to examine EMGdi and sEMGpara during upright cycling where subjects alternated between their hands on and off the handlebars.

Ten healthy subjects (5M:5F, age=24±1yrs; V ̇O2max=53±9 ml×kg-1×min-1) were instrumented with an esophageal electrode catheter to measure crural EMGdi, as well as surface electrodes placed bilaterally on the 2nd parasternal intercostal space to measure sEMGpara.  Participants then underwent an incremental cycle test starting at 100W with the work rate increasing by 50W every 3 minutes until volitional exhaustion.  Subjects alternated between 30 seconds of hands on and 30 seconds off the handlebars during the second half of each stage.
There was no difference in EMGdi across all submaximal exercise intensities (p>0.05) and at maximal exercise (64±11 vs. 62±7%max; p=0.37) when comparing the hands on vs. hands off conditions.  In contrast, sEMGpara was, on average, 74% higher during the hands on vs. hands off condition at submaximal work rates (i.e., 50, 100 and 150W; p<0.05).  The sEMGpara was also significantly higher in the hands on vs. hands off condition at maximal exercise (29±18 vs. 16±9%max, respectively; p=0.04).
These results suggest that activation of the pectoralis muscles at both submaximal and maximal intensities significantly influences the sEMGpara signal.  Consequently, sEMGpara should not be used as a surrogate for EMGdi or dyspnoea, at least during upright cycle exercise.