The Effectiveness of Dance Therapy as an Adjunct to Rehabilitation of Adults With a Physical Disability.

Background/Objective: To determine the added benefit on participants' mobility and participation of a 12-week dance therapy (DT) intervention combined with usual physical rehabilitation for adults with varied physical disabilities. Their appreciation of DT was also explored. Methods: We conducted a quasi-experimental study pre-post test with a nonequivalent control group and repeated measurements pre, post, and at a 3-month follow-up. Results: Although participants in both groups significantly improved over time (at 12 weeks and at follow-up) compared to baseline on mobility (timed up and go, TUG) and participation (e.g., Life-H scores and number of leisure activities), treatment effect analysis using propensity score matching showed no significant treatment effect of DT. The TUG scores showed the best promise of a treatment effect. DT participants' Flow State Scale scores significantly improved (p < 0.01) for 5/9 dimensions of flow (being in control, loss of self-consciousness), and they all recommended DT. Conclusion: This study failed to demonstrate an added benefit of the DT intervention in improving participants' mobility and participation. Overwhelmingly, favorable participants' opinions about the intervention support its potential impact.

Rehabilitation in the real-life environment of a shopping mall.

AIM: The aim of this study was to explore how shopping malls could be used during rehabilitation and to identify the facilitators and barriers to their use. METHOD: Two focus groups, conducted with 15 rehabilitation professionals from various disciplines and working with people with disabilities of all ages were structured around two topics: (i) The usage of malls for rehabilitation and (ii) Factors that facilitate or limit rehabilitation professionals' use of the mall as an environment for clinical assessment and/or intervention. RESULTS: The thematic analysis revealed that shopping malls were used to achieve several rehabilitation goals targeting physical and cognitive skills, psychological health and socialization. This real-life environment is motivating and helps foster independence and normalization. Factors affecting mall use during rehabilitation included personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners). CONCLUSION: Shopping malls may be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities. Implications for rehabilitation To ensure successful community reintegration, clients could be trained at some point during their rehabilitation, to perform activities in real-life settings, such as a shopping mall. Shopping malls appear to enable the attainment of rehabilitation goals targeting a variety of skills. This real-life environment appears to be motivating and helps foster independence and normalization. Factors felt to affect mall use during rehabilitation include personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners). The shopping mall may be an untapped resource as it appears to be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.

Feasibility of delivering a dance intervention for subacute stroke in a rehabilitation hospital setting.

Dance can be a promising treatment intervention used in rehabilitation for individuals with disabilities to address physical, cognitive and psychological impairments. The aim of this pilot study was to determine the feasibility of a modified dance intervention as an adjunct therapy designed for people with subacute stroke, in a rehabilitation setting. Using a descriptive qualitative study design, a biweekly 45-min dance intervention was offered to individuals with a subacute stroke followed in a rehabilitation hospital, over 4 weeks. The dance intervention followed the structure of an usual dance class, but the exercises were modified and progressed to meet each individual's needs. The dance intervention, delivered in a group format, was feasible in a rehabilitation setting. A 45-min dance class of moderate intensity was of appropriate duration and intensity for individuals with subacute stroke to avoid excessive fatigue and to deliver the appropriate level of challenge. The overall satisfaction of the participants towards the dance class, the availability of space and equipment, and the low level of risks contributed to the feasibility of a dance intervention designed for individuals in the subacute stage of post-stroke recovery.

Implementing a novel dance intervention in rehabilitation: perceived barriers and facilitators.

PURPOSE: To identify clinicians' perceptions regarding the facilitators and barriers to the use of dance in rehabilitation. METHODS: This study used a qualitative descriptive design. Three focus groups were conducted with clinicians across three purposively selected rehabilitation centers. Data were analyzed using thematic content analysis. RESULTS: Fourteen allied health-care professionals (six occupational therapists, six physical therapists, and two social workers) with previous dance experience participated in this study. Four main themes emerged from the analysis representing the personal and organizational factors influencing on the implementation of dance interventions: (1) Clinician's dance experience and training, (2) Interest and personal beliefs towards using dance as a potential intervention, (3) Support from the organization of the institution, and (4) Available resources. Although each site was different, the main factors acting as barriers and facilitators were similar for all three sites. CONCLUSION: The identification of the barriers and facilitators to implementing dance in rehabilitation is the first step to support the translation of knowledge about dance. A tailored approach designed for clinicians and managers should address the main barriers to knowledge use about dance, as a potential rehabilitation modality for individuals with disabilities. IMPLICATIONS FOR REHABILITATION: Personal and organizational factors can act simultaneously as barriers and facilitators to the implementation of a dance intervention. Lack of time for professional development and lack of support from the organization are the main barriers to the uptake of knowledge about dance in rehabilitation. A knowledge translation strategy addressing the barriers to knowledge use is helpful for clinicians and managers facilitating the implementation of dance in rehabilitation settings.

[Not Available]. / Une version québécoise du Sport Concussion Assessment Tool 2 (SCAT2)-Outil d'évaluation des commotions cérébrales dans le sport 2 : Québec (SCAT2-Qc).

OBJECTIVE: To translate the Sport Concussion Assessment Tool 2 (SCAT2) based on the French spoken in Quebec and to confirm its acceptability for Quebec's francophone population. METHODOLOGY: The original SCAT2 was translated using a modified approach of the tool translation and adaptation method as proposed by the World Health Organization. A parallel translation was done first. A review of that translation by a committee then led to a preliminary SCAT2-Qc version. A parallel back-translation was then done and compared to the original version. The preliminary version was subsequently modified. The final version was then obtained through comments and suggestions during testing of the tool on two healthy subjects and from the comparison of the SCAT2-Qc with the existing French version by three reviewers from the health field. The final version of the SCAT2-Qc was eventually tested on 12 healthy subjects to ensure its acceptability. RESULTS: The 12 healthy subjects did not experience any comprehension difficulties when using the SCAT2-Qc. CONCLUSION: The translation steps undertaken made it possible to create the SCAT2-Qc that can now be validly used in the Quebec sport and scientific community.

Argentine tango dance compared to mindfulness meditation and a waiting-list control: a randomised trial for treating depression.

OBJECTIVES: To determine whether tango dancing is as effective as mindfulness meditation in reducing symptoms of psychological stress, anxiety and depression, and in promoting well-being. DESIGN: This study employed analysis of covariance (ANCOVA) and multiple regression analysis. PARTICIPANTS: Ninety-seven people with self-declared depression were randomised into tango dance or mindfulness meditation classes, or to control/waiting-list. SETTING: classes were conducted in a venue suitable for both activities in the metropolitan area of Sydney, Australia. INTERVENTIONS: Participants completed six-week programmes (1½h/week of tango or meditation). The outcome measures were assessed at pre-test and post-test. MAIN OUTCOME MEASURES: Depression, Anxiety and Stress Scale; The Self Esteem Scale; Satisfaction with Life Scale, and Mindful Attention Awareness Scale. RESULTS: Sixty-six participants completed the program and were included in the statistical analysis. Depression levels were significantly reduced in the tango (effect size d=0.50, p=.010), and meditation groups (effect size d=0.54, p=.025), relative to waiting-list controls. Stress levels were significantly reduced only in the tango group (effect size d=0.45, p=.022). Attending tango classes was a significant predictor for the increased levels of mindfulness R(2)=.10, adjusted R(2)=.07, F (2,59)=3.42, p=.039. CONCLUSION: Mindfulness-meditation and tango dance could be effective complementary adjuncts for the treatment of depression and/or inclusion in stress management programmes. Subsequent trials are called to explore the therapeutic mechanisms involved.

Effects of expertise and auditory guidance on traditional dance performance.

This study investigated how the dancer's level of expertise and the type of auditory guidance provided influence the kinematic profile of the lower limbs during traditional dance performance. Ten experts in traditional Greek dance (age: 25±3.29 years, five males and five females) and eleven novice participants (age: 26.45±3.88 years, six males and five females), all Greek natives, performed a series of Greek and Irish dance steps with auditory guidance of the metrics (verbal counting) and the music of the respective dances. An electromagnetic tracking system sampled (at 100 Hz) the angular displacement of the two lower legs about the Mediolateral axis during dance performance. Segment rotations were analyzed in the time and frequency domain. Expert dancers displayed significantly lower variability of lower leg rotation and stronger interlimb coupling when compared to novice performers. In novice performers, the power of the lower limb angular displacement extended to higher frequencies when dance performance was guided by music compared to metrical guidance. The addition of music and the origin of the dance interfered with performance for novices but not experienced dancers. Kinematic analysis of the lower limbs may open a new window for the investigation of learning and auditory guidance effects on dance performance.

The effectiveness of task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy.

AIM: The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP). METHOD: We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences. RESULTS: Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up. INTERPRETATION: This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.

Impact of partial administration of the Cognitive Behavioral Driver's Inventory on concurrent validity for people with brain injury.

OBJECTIVES: We sought to determine whether the partial administration of the Cognitive Behavioral Driver's Inventory (CBDI) has a significant effect on its concurrent validity. METHOD: Data were extracted from charts of clients with cerebrovascular accident or traumatic brain injury from three centers. The CBDI was administered either completely or partially (right and left perimetry or Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1982; Picture Completion and Digit Symbol tests were not completed). Concurrent validity indicators were calculated for the CBDI and three different scenarios of partial administration of the CBDI. RESULTS: Only 52% of the road test failures were predicted correctly by the completely administered CBDI. Nonadministration of the WAIS-R rarely modified the CBDI results. Omission of perimetry scores tended to increase the sensitivity and decrease the specificity (not significantly). CONCLUSION: The CBDI should be used as a complement, not a substitution, for a road test. Partially administrating the CBDI, specifically excluding perimetry measures, can affect its concurrent validity.

Reliability of kinematic measures of functional reaching in children with cerebral palsy.

AIM: The determination of rehabilitation effectiveness in children with cerebral palsy (CP) depends on the metric properties of the outcome measure. We evaluated the reliability of kinematic measures of functional upper limb reaching movements in children with CP. METHOD: Thirteen children (ten females, three males) with spastic hemiplegic, diplegic, or quadriplegic CP affecting at least one arm (mean age 9y, SD 1.6y; range 6-11y; Manual Ability Classification System [MACS] levels II-IV) were evaluated three times over 5 weeks. The kinematics of the more affected arm reaching to grasp a 2cm(3) block placed at three distances from the body midline were analysed. The reliability (test-retest) of six kinematic variables (endpoint trajectory straightness and smoothness, trunk displacement, elbow extension, shoulder horizontal adduction, and shoulder flexion] was tested and expressed as intraclass correlation coefficients (ICC, model 2,K) and 95% confidence intervals. RESULTS: Trajectory smoothness, trunk displacement, elbow extension, and shoulder flexion (far target) had the highest ICCs (0.82-0.95). Other kinematic variables had moderate (0.50< or =ICC< or =0.81) or low (0.17-0.38) reliability. Test-retest reliability was task dependent, as reaches required different degrees of trunk displacement and joint excursion. INTERPRETATION: Kinematic variables can be used as outcomes in clinical trials to test upper limb intervention effectiveness on motor performance and movement quality. As kinematic variables are task specific, reliability should be interpreted in the context of task requirements.

Sensori-motor and daily living skills of preschool children with autism spectrum disorders.

Sensori-motor development and performance of daily living skills (DLS) remain little explored in children with autism spectrum disorders (ASD). The objective of this study was to determine the impact of sensori-motor skills on the performance of DLS in preschool children with ASD. Thirty-five children, 3-4 years of age, were recruited and assessed with a battery of diagnostic and clinical tests. Children showed atypical sensory responses, very poor motor and DLS. Sensory avoiding, an excessive reaction to sensory stimuli, and fine motor skills were highly correlated with DLS, even when cognitive performance was taken into account. Sensori-motor deficits have an impact on the autonomy of children with ASD and interventions should aim at improving and supporting the development of sensori-motor skills.

Effect of a community-based Argentine tango dance program on functional balance and confidence in older adults.

Tango-dancing and walking programs are compared in nondemented seniors at risk for falls. Fallers (N = 30) age 62-91 were randomly assigned to a 10-wk (40 hr, 2 hr 2x/wk) tango class or walk group. The Activities-specific Balance Confidence (ABC) scale, sit-to-stand scores, and normal and fast walk were measured pre-, post-, and 1 month postintervention. Two-way repeated-measures ANOVAs indicated a significant main effect (p < .01) for time on all measures. Group and interaction effects for ABC led to improvement only in tango because of high baseline mean for the walk group. Clinical improvements measured using Established Populations for Epidemiologic Studies of the Elderly scoring were greater for the tango group. From these preliminary results it is suggested that although both interventions are effective activities for increasing strength and walk speed, tango might result in greater improvements than walking in balance skills and in walking speed in the 10-wk intervention. The study needs to be repeated with a greater sample size to determine the effectiveness of walking on fear of falling.

Test-retest reliability and internal consistency of the Quebec-French version of the Survey of Pain Attitudes.

OBJECTIVE: To determine the test-retest reliability and internal consistency of the Quebec-French version of the Survey of Pain Attitudes (QAD/F-SOPA). DESIGN: Measurement of test-retest reliability (2-wk interval) and internal consistency. SETTING: Five rehabilitation settings that offer services to chronic pain patients. PARTICIPANTS: Convenience sample of 69 Francophone adults (having either French as the mother tongue or a good mastery of French) with musculoskeletal pain for a minimum of 6 months and stable pain condition during the test-retest interval. INTERVENTIONS: Completion of the QAD/F-SOPA twice within a 2-week interval. MAIN OUTCOME MEASURES: Test-retest reliability (Pearson r , 2-tail paired t test, P <.001) and internal consistency (Cronbach alpha at time 1). RESULTS: Fifty-six subjects completed the QAD/F-SOPA on both occasions. Except for the disability subscale, the r values fell between 0.7 and 0.9 (high correlation). For the paired t test, all subscales (except for control and medication) had a P value greater than .05, confirming their test-retest stability. All subscales showed satisfactory internal consistency estimates (0.7-0.9) except for the harm (.67) and disability (.64) subscales. CONCLUSIONS: Globally, the QAD/F-SOPA has good reliability and validity properties and meets the prerequisites for use for clinical and research purposes. The disability subscale shows weaker properties; further studies would help determine how it could be improved.

A pattern recognition technique to characterize the differential modulation of co-activating muscles at the performer/environment interface.

The purpose of this research was to develop and test an analytical tool that would recognize and classify the surface electromyographic (EMG) signal of co-activating muscles of the leg into pre-defined patterns of muscle activity: burst, tonic, and tonic-burst. Developed to study the task of landing from a jump in children, the pattern recognition technique (PRT) quantifies the full-wave rectified surface EMG signal over a short-duration sampling window by a single linear regression value. Shifting the sampling window across the data string ultimately defines the signal by a set of regression values that produce the recognizable burst, tonic and tonic-burst patterns on a least-squares surface plot. Statistical comparison of the PRT to the classical combination of threshold detection (+2 S.D. of mean baseline activity) and visual inspection proves the PRT to be more reliable on repeated measures for event detection and classification, with a Kappa statistic of 0.83 compared to 0.54 for threshold detection. Application of the PRT to motor control studies is presented for the regulation of the mechanical response of the leg during impact. Responsiveness of the PRT is tested, issues of accuracy and validity are addressed, and limitations in spatial-temporal resolution are identified.

The Montréal Rehabilitation Performance Profile: a statistical model for assessing stair descent in children with cognitive impairments.

OBJECTIVES: To characterize the responsiveness of the Montréal Rehabilitation Performance Profile (MRPP); to measure the differential effectiveness of a task-specific (TS) and a task-nonspecific (TNS) motor learning format to promote alternating stair descent in children with cognitive impairments; and to evaluate the relevance of the MRPP to evidence-based practice. DESIGN: Randomized comparison of 2 age-matched groups; psychometric testing of measurement tool. SETTING: School for children with developmental and cognitive impairments. PARTICIPANTS: Ambulatory sample of convenience: 18 children, age 5 to 9 years, with moderate to severe cognitive impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The MRPP variables measured at baseline; end of 10-week intervention; and 5 and 10 weeks postintervention. Analysis of variance for repeated measures and part-whole correlation. RESULTS: Global stair descent performance improved for both TS and TNS groups over time (P=.001). However, a specific acquisition and retention of the alternating pattern of descent was associated with the TS format. CONCLUSION: The MRPP was responsive to small differences in stair descent performance that are specific to the format of the motor learning intervention. The MRPP allows clinicians to determine the timing of the intervention needed to maintain or improve stair descent ability.

The development of coordination for reach-to-grasp movements in children.

When adults reach to grasp stationary targets, movement kinematics (endpoint trajectories, interjoint coordination) are highly stereotyped and stable. The emergence of an optimal coordination for reaching involves mastering the redundant number of degrees of freedom while the body grows. Reaching has been well studied in healthy children under the age of 3 years. We characterised the development of coordination during reaching in children over the age of 3 years and identified age ranges in which stable patterns emerge. A random sample of 38 healthy children aged 4-11 years and nine adults participated in the study. They reached from the seated position with the dominant arm and grasped a cone placed at three distances in the forward sagittal plane in front of the body. Kinematic data from markers placed on the arm, head and trunk were recorded at 100 Hz (Optotrak Motion Analysis System). Immature patterns of reaching were characterised by increased variability in younger compared to older children. Hand trajectories became smoother and less variable with age. Interjoint coordination became more consistent, while trunk displacement and variability decreased with age. Only children between 8 and 10 years old had variability similar to adults. Our data suggest that different aspects of movement kinematics mature at different rates. However, our data do not support the idea of a sequential maturation of different biomechanical variables.