Dissertation
Upper Limb Associated Reactions in People with Acquired Brain Injury: Developing a Dynamic Assessment During Walking and Investigating Related Impairments
University of the Sunshine Coast, Queensland
Doctor of Philosophy, University of the Sunshine Coast, Queensland
2021
DOI:
https://doi.org/10.25907/00045
Abstract
Acquired brain injury (ABI) encompasses conditions such as stroke, traumatic brain injury, and cerebral tumours. The burden of ABI is widespread; stroke is the leading cause of worldwide disability and traumatic brain injury is the primary cause of severe disability for young adults. Associated reactions (ARs) of the hemiplegic upper limb are an example of the complex physical sequalae resulting from ABI. The phenomenon of ARs is widely observed and reported in neurorehabilitation. It is understood to be a released postural reaction, deprived of voluntary control, and triggered by effort. Therefore, when performing functional tasks such as walking, people with ARs experience increased tone or movement in their hemiplegic upper limb, causing awkward, often uncomfortable limb postures. These ARs may adversely impact walking ability, dynamic balance, energy expenditure, upper limb movement and function, aesthetics, and may cause contractures. Despite this, the AR literature possesses four key challenges; 1) problems with terminology; 2) no existing gold-standard clinical or research outcome measure; 3) ambiguous contributing factors to the expression of ARs; and 4) no strong evidence to support varied treatment approaches. Based on this, the need for further AR research is apparent. This thesis was designed to address these identified challenges, particularly with respect to AR assessment. The initial aim of the thesis was to undertake a systematic review of the literature (Study 1) to determine the existing AR assessment methods and evaluate their clinimetric properties. Prior to performing the review, AR terminology was delineated, and a specific AR definition was devised to address the first challenge identified. The review reported six key findings regarding AR assessments; 1) assessments were commonly performed in stationary, seated positions; 2) maximal voluntary isometric contractions (MVIC) of the unaffected upper limb were frequently used to induce the AR; 3) both the seated testing positions and maximal effort protocols did not reflect the dynamic functional occurrence of ARs, indicating limited ecological validity for functional tasks; 4) testing protocols focussed mostly on the elbow joint; 5) clinimetric properties were limited; and, 6) many assessment methods had poor clinical utility. These findings underpinned the subsequent aims and studies of this thesis.
Details
- Title
- Upper Limb Associated Reactions in People with Acquired Brain Injury: Developing a Dynamic Assessment During Walking and Investigating Related Impairments
- Authors
- Michelle Kahn
- Contributors
- Ross Allan Clark (Supervisor) - University of the Sunshine Coast, Queensland, School of Health and Sport Sciences - Legacy
- Awarding institution
- University of the Sunshine Coast, Queensland
- Degree awarded
- Doctor of Philosophy
- Publisher
- University of the Sunshine Coast, Queensland
- DOI
- 10.25907/00045
- Organisation Unit
- University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy; School of Health - Public Health
- Language
- English
- Record Identifier
- 99510305702621
- Output Type
- Dissertation
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