Browsing by Author "Schneider, Kathryn"
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Item Open Access A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study(2022-08-01) Habberfield, Jeff; Schneider, Geoff; Schneider, Kathryn; Katuli, Sozina; Olson, LeeAbstract Background Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. Methods Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. Results Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. Conclusion This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.Item Open Access A real-time assessment of the relationship between neuronal activation and hemodynamic changes in humans(2024-08-29) Burma, Joel Stephen; Smirl, Jonathan; Dunn, Jeffrey; Schneider, Kathryn; Debert, ChantelThis dissertation aimed to develop and employ a novel multimodal neuroimaging approach utilizing electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), transcranial Doppler ultrasound (TCD), finger photoplethysmography, electrocardiography, and capnography to study neurological, cerebrovascular, and cardiorespiratory responses during motor and visual tasks. The dissertation adopted a step-by-step approach for method development. Initially, a thorough systematic review of previous multimodal neuroimaging studies investigating neurovascular coupling/functional hyperemia was conducted to identify common limitations and equipment combinations (Chapter 2). This review informed the development of a novel concurrent integration of EEG-fNIRS-TCD neuromonitoring techniques with systemic physiological monitoring, detailed in Chapter 3. Following this, a pilot study involving 15 participants was conducted to assess the data quality from the three imaging modalities during resting motor (finger tapping) and visual (“Where’s Waldo/Wally?”) tasks (Chapter 4). These tasks were then performed during transient blood pressure oscillations induced by squat-stand maneuvers at 0.05 and 0.10 Hz to challenge the cerebrovasculature (Chapter 5), demonstrating that the neurovascular coupling task remained stable despite significant blood pressure fluctuations. Overall, the findings from this dissertation underscore the robustness of the EEG-fNIRS-TCD approach in capturing neuronal and cerebral hemodynamic responses across various tasks and hemodynamic challenges, providing better insight into cerebrovascular regulation.Item Open Access Characterizing Clinical Presentations following Mild Traumatic Brain Injury: Mechanisms of Injury and Dizziness Subtypes(2024-01-22) Holte, Kirsten Elizabeth; Schneider, Kathryn; Lun, Victor; Debert, Chantel; Subramaniam, SureshThis MSc thesis explores clinical presentations following mild Traumatic Brain Injury (mTBI) and includes two studies. The first study evaluates the association between symptom severity score, Vestibular Ocular Motor Screen, vestibulo-ocular reflex (VOR), oculomotor, and cervical spine function and 1) mTBI mechanism and 2) sport type in 98 youth (6-17 years) presenting to acute mTBI clinics (Calgary and Montreal sites). Forty-six males and 55 females sustained a non-sport related concussion (nSRC; n= 18) or sport-related concussion (SRC; n= 80), in contact sport (n=62), or non-contact sport (n=18). No statistically significant differences were found in any outcome by mTBI mechanism. Athletes injured in non-contact sport had a 12.69 (95% CI: 2.38-78.79) times higher odds of abnormal VOR gain compared to those in contact sport. Future research is warranted, including comparison to pre-injury status, to better understand the mechanism driving the differences in VOR by sport type. The second study examines concurrent validity of dizziness subtype classification between a physiotherapist and physician specialist, and test-retest reliability by a physiotherapist in 21 youth and adults diagnosed with SRC. Dizziness subtypes included Benign Paroxysmal Positional Vertigo, Unilateral Peripheral Vestibular Hypofunction, cervicogenic dizziness, centrally mediated dizziness, vestibular migraine, and other. Substantial agreement (k= 0.67, 95% CI 0.35-1.00) was found between the physiotherapist and physician specialist and almost perfect agreement between physiotherapist classifications at the initial and 7-day assessments (k= 1.00, 95% CI 0.56-1.00). At the initial assessment, 71.43% and 35.71% of participants had at least one dizziness subtype categorized as “other” by the physiotherapist and physician specialist, respectively, and multiple dizziness subtypes were selected by both raters for 42.86% of participants. This work will inform the refinement of subtype classification processes, including the addition of potential subtypes to enable further classification. Future research is needed to evaluate a refined version of the subtype classification system in a larger prospective cohort study to further inform dizziness subtype management.Item Open Access Concussion Management: Examining Movement Behaviours in Adolescents Following Concussion(2024-08-27) Kennedy, Courtney; Smirl, Jonathan; Emery, Carolyn; Schneider, Kathryn; Brassard, Patrice; Russell, KellyConcussion management guidelines have evolved over time and current recommendations indicate a gradual reintroduction to sub-symptom threshold activity following a brief (24-48 hour) period of relative rest. Both excessive rest and activity following concussion have been shown to be associated with adverse outcomes, suggesting a dose-response relationship between activity and recovery. However, the optimal frequency, timing, and duration of activity to augment recovery has yet to be delineated following concussion. Movement behaviours, including physical activity, sedentary behaviour, and sleep, are finite in nature and effectuate both independent and collective effects contributing to health outcomes. Concussion related impairments can manifest as functional disturbances encompassing numerous sleep/wake domains; however, activity and sleep patterns are often examined independently among adolescents following concussion. There is a limited understanding of the differential effect of activity across the intensity spectrum, as the accumulation of physical activity and sedentary behaviour across the wakeful day has yet to be explored in adolescents’ post-injury. This MSc project contains two projects focused on quantifying movement behaviour patterns including the volume of sedentary time, light-, moderate-, vigorous-intensity physical activity, and sleep. The first project evaluates movement behaviour metrics in healthy adolescents and adolescents diagnosed with a concussion. The second project examines the differential effect of movement behaviour volume on recovery trajectories. The comprehensive evaluation of physical activity, sedentary behaviour, and sleep patterns can aid in delineating the optimal balance between rest and activity, and ultimately inform evidence-based movement guidelines in the management and rehabilitation of concussion.Item Open Access Dizziness, Neck Pain and Headaches Following Sport-Related Concussion: Symptoms, Risk Factors and Physiotherapy Management(2013-01-29) Schneider, Kathryn; Meeuwisse, Willem; Emery, CarolynSport-related concussion is a commonly occurring injury in sport today. Little is currently known about baseline symptoms and Sport Concussion Assessment Tool (SCAT) scores in youth athletes. Additionally, symptoms of dizziness, neck pain and headaches are commonly reported in the youth population and there is currently no literature evaluating these symptoms as risk factors for incident concussion. There is a paucity of literature currently available evaluating treatment for individuals with persistent symptoms following a sport-related concussion. Thus, while there has been an explosion of research in the area of sport-related concussion, there remain gaps in the current literature specifically relating to symptoms as risk factors for concussion and physiotherapy treatment for individuals with persistent symptoms. In this document, baseline symptoms and scores on the SCAT were evaluated and presented. Reports of dizziness, neck pain and headaches at the start of the season were found to be risk factors for concussion. A systematic review evaluating rest and treatment for individuals with persistent symptoms following a sport-related concussion found that there is minimal evidence currently available. In a randomized controlled trial, individuals who were treated with multimodal physiotherapy treatment, including vestibular rehabilitation, were 10 times more likely to be medically cleared to return to sport within eight weeks of initiation of treatment. Multimodal physiotherapy treatment should be considered for individuals with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.Item Open Access Electrical Vestibular Stimulation for Probing the Effect of Combat Sports on Balance Control(2024-04-29) Banman, Christopher James; Peters, Ryan; Cluff, Tyler; Schneider, KathrynCombat athletes are at a high risk for head injuries such as concussion. Recent work has uncovered that even repetitive head impacts (RHIs) may have lasting effects on cognitive, emotional, and motor function. This thesis will focus on the changes to vestibulospinal processing seen in combat athletes. Electrical vestibular stimulation (EVS) was used to evoke vestibulospinal reflexes, comparing the resulting responses between combat athletes and healthy sex/age matched controls. This is described through three separate chapters. First, I test the differences in electromyography (EMG) responses, then develop a novel EVS-induced postural sway thresholding technique, and finally investigate the EVS threshold differences between the fighters and controls. The experimental results of the first study demonstrated frequency-specific changes in vestibular sensitivity to EVS for combat athletes, via EMG responses. Combat athletes showed an increased sensitivity to low frequency EVS, and a decreased sensitivity to high frequency EVS, resulting in increased latencies on short and medium latency reflexes, scaling with increasing career RHI exposure. The second study presented shows that stochastic electric vestibular stimulation (SVS) can be used to determine EVS postural sway thresholds much lower than those that have previously been shown in the literature. The second study also shows that humans appear to be more sensitive to bipolar EVS than monopolar EVS. The third study found that combat athletes had lower EVS-induced sway thresholds using low frequency EVS than their matched controls. Taken together this thesis displays significant changes to vestibulospinal processing with increased RHI exposure in combat athletes.Item Embargo Evaluating Aerobic Exercise to Improve Symptom Burden and Quality of Life in Adults with Persistent Post-Concussive Symptoms(2023-06) Mercier, Leah Jordan; Dukelow, Sean; Debert, Chantel; Esser, Michael; Schneider, KathrynAdults who sustain a mild traumatic brain injury (mTBI) and go on to develop persistent post-concussive symptoms (PPCS) struggle to manage their symptoms and return to pre-morbid activity. There are few evidence-based treatments that have shown benefit in improving PPCS. Prescription of sub-symptom threshold aerobic exercise following mTBI has gained attention in recent years; however, the literature has largely focused on adolescents with sport-related mTBI despite the potential role of aerobic exercise in the treatment of adults with PPCS. This thesis begins by characterizing physical activity (PA) and sedentary behavior and their associations with symptom burden and quality of life (QoL) in adults with PPCS. Next, a systematic review describes the evidence for autonomic dysfunction, namely through evaluation of heart rate variability (HRV), following mTBI. Limitations of the literature including confounding variables that may influence interpretation of results are discussed. The next chapter is the protocol of a randomized clinical trial evaluating a sub-symptom threshold aerobic exercise intervention for improvement in symptom burden, QoL, specific symptom outcomes and sleep. In the following chapter, the results of the trial are presented. The thesis goes on to evaluate changes in heart rate, HRV, blood pressure and cardiac baroreceptor sensitivity between adults with PPCS and age/sex-matched controls. In the PPCS group, longitudinal changes in autonomic metrics following an aerobic exercise intervention are also presented. This work builds on our knowledge of PA and sedentary behavior in adults with PPCS and how aerobic exercise may play a role in the treatment of this patient population. Significant improvements in symptom burden, QoL and other specific symptom outcomes were observed following 6-weeks of aerobic exercise. These outcomes did not significantly improve following 6-weeks of stretching. Lower resting HRV in adults with PPCS compared to age/sex-matched controls and blunted response to postural change provides evidence of cardiovascular autonomic dysfunction in this cohort, although improvement in these outcomes was not observed with the exercise intervention. This thesis provides data to suggest adults with PPCS can benefit from sub-symptom threshold exercise and prescription of aerobic exercise should be considered in the chronic phase of injury despite persistence of symptoms.Item Open Access Pediatric Concussion Health Service Utilization and Follow-Up Care: A Population-Based Epidemiological Study Using Administrative Health Data(2021-08-19) Wittevrongel, Krystle; Zwicker, Jennifer; Yeates, Keith; Schneider, Kathryn; Hagel, BrentConcussion is a common injury among children and youth, although population-level incidence and trends related to service use are not well described in the literature. In addition, while treatment and management decisions are led by best practices and clinical guidelines, there is a paucity of studies exploring the individual and contextual factors that impact health service utilization following concussion in the pediatric patient. Thus, the objective of this thesis was to address these gaps and better understand how children and youth are interacting with the health care system following concussion in Alberta. In this thesis, 14-years of system-level linked administrative health data and a defined episode of care (EOC) were used to describe trends in health care utilization following pediatric concussion in Alberta. An increased incidence of concussion and other mild head injury diagnoses was observed across the province. In addition, a shift in care from emergency department (ED) to outpatient physician office (PO) settings and a higher use of the ED by some segments of the population was observed. Findings suggest some children and youth are more likely to receive care following a concussion. In addition, follow-up care increased over time, demonstrating accordance with clinical guidelines. However, rates remained low, indicating a lack of application by provider or adherence by patient. Findings indicate that the likelihood of receiving follow-up care in Alberta was influenced by both individual and contextual factors. Factors related to need (perceived and evaluated) were most strongly associated with health care utilization. The index visit occurring in PO had the strongest positive association with follow-up care, followed by a history of concussion-related EOC. At the same time, patient predisposing and enabling factors also affected utilization. Younger children and youth, females, and those from areas of lower socioeconomic status (SES) or residing in certain geographical areas were less likely to receive follow-up care. Findings suggest that to improve service delivery and targeted treatment in line with clinical guidelines for all children and youth, policies that focus on equitable access are needed.Item Open Access Physical and Cognitive Activity and Recovery From Sports Related Concussion(2016) Lishchynsky, Justin; Schneider, Kathryn; Yeates, Keith; Emery, Carolyn; Toomey, ClodaghConcussions are among the most common injuries in youth sport and can affect an individual both cognitively and physically, thus proper clinical care is imperative. In this thesis, a review of physical and cognitive activity and rest following concussion highlights the need for more research to better define the optimal amounts and types of rest and activity to facilitate recovery. Comparing Actigraph accelerometry to participant self-report data during concussion recovery revealed poor agreement and correlation between the two. There was no association between cognitive activity and recovery from concussion demonstrated in an exploratory analysis of high and low levels of cognitive activity. More time performing moderate-vigorous physical activity (>45 minutes daily) was associated with a significantly longer time to return to baseline symptom scores and being medically cleared to return to play. Future high level studies evaluating the impact of physical activity on recovery are needed to inform clinical practice.Item Open Access Setting the Standard: Injury, Concussion, and Performance in Youth Volleyball(2022-05) Vaandering, Mackenzie; Schneider, Kathryn; Emery, Carolyn; Hagel, Brent; Pasanen, KatiThis thesis contains three projects focused on Canadian youth community volleyball. The first project is a prospective cohort study evaluating injury epidemiology during the 2018 Canadian Youth National Volleyball Tournament. It was found that rates of injury in U14 were higher than U18, with high rates of injury in tournament play. The second project evaluated the test-retest reliability of a series of volleyball performance measures (i.e., modified agility t-test, modified pro agility, spike approach jump height, serve velocity, attack velocity and the Y-balance test). Most measures, excluding serve and attack velocity, were found to be reliable. The third project is a cross-sectional study describing performance scores on these measures. Males were faster on both agility tests, jumped higher, and achieved faster serve velocities than females. In the future, the addition of performance metrics may be beneficial to assess skill development and performance changes with injury prevention programs.Item Open Access The reality of NMT warm-up programs: Does research translate into real-world implementation?(2023-06-14) Lutz, Destiny; Emery, Carolyn; Schneider, Kathryn; Pasanen, Kati; Owoeye, Oluwatoyosi; Bizzini, MarioThis MSc thesis includes two manuscript-style chapters focused on the best practices for the dissemination and implementation (D&I) of neuromuscular training (NMT) warm-ups programs in youth team sport and video analysis of warm-up procedures in Calgary youth soccer. The systematic review examined the current practices for the D&I of NMT warm-up programs in youth (19 years old) team sport. Key results from this systematic review indicate there are few high-level studies evaluating D&I strategies for NMT warm-up program delivery. Limited studies utilize D&I behaviour change frameworks/models. Coach workshops with supplementary resources are the primary strategy and facilitator for implementation success. The second study takes a deeper dive into implementation, looking at real-world usage of NMT warm-up programs in a local context using video analysis. This study investigated U13-U17 male and female elite and non-elite Calgary youth soccer warm-ups for both practices and games during the outdoor 2022 season. Findings of this study determined limited mean time spent in overall warm-ups (322.4 seconds/session; 95% CI: 250.3, 394.5) and minimal time spent in NMT components (202.2 seconds/session; 95% CI: 150.3, 254.2) across all teams. Significant increase in mean time spent in aerobic was found for male elite teams for practice warm-ups in the beginning of the season (timepoint 1) compared to mid-season (timepoint 2, p = 0.005; timepoint 3, p < 0.001; and timepoint 4, p < 0.001). No other changes were found from the remaining groups, regardless of session type. When evaluating differences in overall warm-ups and time spent in NMT components, male elite teams spent more mean time in aerobic than female elite teams in practice warm-ups (-335.8 seconds, 95% CI: -413.8, -257.8); no differences were seen in games. No significant differences were found between male and female non-elite teams for either session type. Despite recommendations, the status of warm-up program implementation in youth team sport globally, and youth soccer setting locally, do not reflect research suggestions for achieving health-related benefits. Overall, these studies highlight the need for more pragmatic efforts to promote successful, long-term uptake of NMT warm-up programs, suggesting further incorporation of critical NMT components into routines.Item Embargo The Safety and Feasibility of Transcranial Direct Current Stimulation for the Treatment of Chronic Cervicogenic Headaches(2024-06-24) Jobin, Kaiden D.; Debert, Chantel; Smith, Ashley; Schneider, Kathryn; Kirton, AdamCervicogenic headaches (CGH) are a highly debilitating condition whereby individuals primarily experience neck pain, headaches, and impaired neck function. Onset occurs frequently after whiplash injury, concussion, and degeneration of the cervical joints. Although therapies such as pharmacotherapy and exercise provide relief to some patients suffering from CGH, many patients do not find benefit from these interventions alone. Neuromodulation therapies such as transcranial direct current stimulation (tDCS) have recently shown promise in other headache and pain conditions. As such, we designed a double-blinded, sham-controlled, randomized trial to consider the safety and feasibility of tDCS combined with exercise therapy (ET) for patients with chronic CGH. Secondarily, we sought to explore the efficacy of active tDCS/+ET compared to sham tDCS/+ET on outcomes evaluating headache, pain, quality of life, and neck function. We found this intervention to be both safe and feasible for individuals with CGH, demonstrating high recruitment, retention, and adherence as well as no serious adverse events. Furthermore, we found significant group-time interactions favouring the active tDCS/+ET group with respect to headache intensity and frequency as well as pain and fine motor control of the deep cervical flexors. From these findings, a larger, adequately powered, clinical trial is warranted.Item Open Access “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework(2021-02-05) Ly, Anh; Zemek, Roger; Wright, Bruce; Zwicker, Jennifer; Schneider, Kathryn; Mikrogianakis, Angelo; Conradi, Alf; Johnson, David; Clark, Brenda; Barlow, Karen; Burey, Joseph; Kolstad, Ash; Yeates, Keith OAbstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.