Ottawa Hospital Rehabilitation Center

Ottawa, Canada

Ottawa Hospital Rehabilitation Center

Ottawa, Canada
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Kendell C.,Ottawa Hospital Rehabilitation Center | Lemaire E.D.,Ottawa Hospital Rehabilitation Center | Losier Y.,University of New Brunswick | Wilson A.,University of New Brunswick | And 2 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2012

A 3×4 electrode array was placed over each of seven muscles and surface electromyography (sEMG) data were collected during isometric contractions. For each array, nine bipolar electrode pairs were formed off-line and sEMG parameters were calculated and evaluated based on repeatability across trials and comparison to an anatomically placed electrode pair. The use of time-domain parameters for the selection of an electrode pair from within a grid-like array may improve upon existing electrode placement methodologies. © 2012 Kendell et al.; licensee BioMed Central Ltd.


Laferriere P.,Ottawa Hospital Rehabilitation Center | Chan A.D.C.,Carleton University | Lemaire E.D.,Ottawa Hospital Rehabilitation Center
2010 IEEE International Workshop on Medical Measurements and Applications, MeMeA 2010 - Proceedings | Year: 2010

A new flexible, dry electrode is examined for recording surface electromyographic signals and compared to a conventional Ag/AgCl electrode. A suitable dry electrode would enable practical implementation of wearable mobility monitoring systems. Results from a preliminary experiment are presented in this paper. Measurements were performed on the right tibialis anterior during a series of small and large contractions. The effects of skin preparation, which included shaving and cleaning with isopropyl alcohol, are also examined. Results show that the dry electrode is sensitive enough to detect the small, unloaded muscle contractions. The dry electrode signal strength was similar to the Ag/AgCl electrode; however, the noise level was higher by approximately 13.5±1.3 %. Skin preparation reduced the noise level by approximately 7.9% for the dry electrodes and 8.1% for the Ag/AgCl electrodes. ©2010 IEEE.


Clavet H.,University of Ottawa | Doucette S.,Ottawa Health Research Institute | Trudel G.,University of Ottawa | Trudel G.,Ottawa Hospital Rehabilitation Center
Disability and Rehabilitation | Year: 2015

Purpose: To investigate the mortality, quality of life and functional limitations of intensive care unit (ICU) patients with and without joint contractures 3.3 years after discharge from the hospital. Methods: 155 consecutive patients admitted to a primary care referral centre ICU for 2 or more weeks with information on joint range of motion formed a retrospective cohort. The EuroQol and a Joint Contracture Questionnaire were administered to the cohort survivors. Results: Fifty patients returned the questionnaires, 57 did not return the questionnaire, and 48 were deceased. The patients who had died presented significantly more joint contractures in the ICU than the respondents and the non-respondents (p = 0.003 and p = 0.006, respectively). More respondents who reported limitations in their mobility on the EuroQol had joint contractures in ICU 13/18 (72.2%) compared to respondents who did not have contractures 7/21 (33.3%; p = 0.02). Conclusions: Joint contractures in ICU were associated with higher mortality. Patients who spent 2 weeks or more in ICU and developed joint contractures identified more difficulty with mobility 3.3 years after discharge; joint contractures may impose irreversible disability. A strategy to identify and treat joint contractures in ICU may prevent long-term functional limitations. © 2015 Informa UK Ltd.


Spring A.N.,University of Waterloo | Kofman J.,University of Waterloo | Lemaire E.D.,Ottawa Hospital Rehabilitation Center
IEEE Transactions on Neural Systems and Rehabilitation Engineering | Year: 2012

Individuals with quadriceps muscle weakness often have difficulty generating the knee-extension moments required to complete common mobility tasks. A new device that provides knee-extension moments through a range of knee angles was designed to help individuals perform stand-to-sit and sit-to-stand tasks. The novel knee-extension assist (KEA) was designed as a modular component to be incorporated into existing knee-ankle-foot orthoses or used in a knee orthosis. During stand-to-sit, a set of springs is loaded as the knee flexes under bodyweight and the KEA thus provides a knee-extension moment that aids in achieving a smoothly controlled knee flexion. The springs can be locked in place at the end of knee flexion to prevent unwanted knee extension while the user is seated. The entire knee extension assist can be disengaged to allow free joint motion anytime the affected leg is unloaded. During sit-to-stand, the KEA assists knee extension by returning the energy stored in the springs as an extension moment. In mechanical testing of a prototype of the new KEA, a mean maximum extension moment of 42.9 $\pm$ 0.46 Nm was provided by the device during flexion and 28.4 $\pm$ 0.28 Nm during extension. A biomechanical evaluation with two able-bodied individuals demonstrated the effectiveness of the KEA in successfully assisting stand-to-sit and sit-to-stand tasks. During stand-to-sit, the KEA provided 82% and 75% of the total (muscle and KEA) knee-extension moment required by the braced leg for the task for the two subjects, respectively; and during sit-to-stand, the KEA provided 56% and 50% of the total knee-extension moment for the two subjects, respectively. This KEA performance exceeded 50% knee-extension moment assistance for a 70 kg person. © 2011 IEEE.


Campbell T.M.,Ottawa Hospital Rehabilitation Center | Campbell T.M.,University of Ottawa | Trudel G.,Ottawa Hospital Rehabilitation Center | Trudel G.,University of Ottawa | And 2 more authors.
Journal of Rheumatology | Year: 2014

Objective. Knee flexion contractures (KFC) are limitations in the ability to fully extend the knee joint. In people with knee osteoarthritis (OA), KFC are common, impair function, and worsen outcomes after arthroplasty. In KFC, the posterior knee capsule is believed to play a key role, but the pathophysiology remains poorly understood. We sought to identify gene expression differences in the posterior knee capsule of patients with O A with and without KFC. Methods. Capsule tissue was obtained from the knees of 12 subjects diagnosed with advanced-stage O A at the time of knee arthroplasty surgery. The presence or absence of KFC allocated patients into 2 groups using a case-control design. Genome wide capsular gene expression was compared between the 2 patient groups. Confirmation of differential expression of the corresponding proteins was performed by immunohistochemistry on tissue sections. Results. There were no significant demographic differences between the patients with OA with KFC and without KFC save for reduced extension in their surgical knee (p < 0.01). KFC patients showed a 6.4-fold decrease in CSN1S1 (p = 0.017) gene expression and a 3.7-, 2.0-, and 2.6-fold increase in CHAD, Sox9, and Cyr61 gene expression, respectively (p = 0.001, 0.004, 0.001, respectively). There were corresponding increases in protein levels for chondroadherin, sex determining region Y-box 9, and casein alphaS1 (all p < 0.05). Functional analysis of the differentially expressed genes indicated a strong association with pathways related to the extracellular matrix and to tissue fibrosis. Conclusion. Posterior capsules in endstage OA knees with KFC exhibited differential expression of 4 genes all previously documented to be associated with tissue fibrosis. Copyright © 2014. All rights reserved.


McKim D.A.,Ottawa Hospital Rehabilitation Center | McKim D.A.,University of Ottawa | Katz S.L.,University of Ottawa | Katz S.L.,Ottawa Hospital Research Institute | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Objective: To evaluate the long-term effect on measures of forced vital capacity (FVC) before and after the introduction of regular lung volume recruitment (LVR) maneuvers (breath-stacking) in individuals with Duchenne muscular dystrophy (DMD). Design: Retrospective cohort study of pulmonary function data, including FVC, cough peak flow (CPF), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). Data were collected for 33 months prior to and 45 months after LVR introduction. Setting: Ambulatory care in a tertiary level regional rehabilitation center in Canada. Participants: All individuals (N=22) with DMD (mean age ± SD, 19.6±2.4y), who were prescribed LVR and reported adherence with therapy. Interventions: Introduction of regular LVR (breath-stacking); 3 to 5 maximal lung inflations (maximum insufflation capacity [MIC]) using a hand-held resuscitation bag and mouthpiece, twice daily. Main Outcome Measures: Measures included the rate of decline of FVC in percent-predicted, before and after the introduction of regular LVR. Changes in maximum pressures (MIP, MEP), MIC, and cough peak flows were also measured. Results: At LVR initiation, FVC was 21.8±16.9 percent-predicted, and cough peak flows were <270L/min (144.8±106.9L/ min). Annual decline of FVC was 4.7 percent-predicted a year before LVR and 0.5 percent-predicted a year after LVR initiation. The difference, 4.2 percent-predicted a year (95% confidence interval, 3.5-4.9; P<.000), represents an 89% improvement in the annual rate of FVC decline. Conclusions: The rate of FVC decline in DMD patients improves dramatically with initiation of regular LVR. © 2012 American Congress of Rehabilitation Medicine.


Trudel G.,University of Ottawa | Laneuville O.,University of Ottawa | Coletta E.,University of Ottawa | Goudreau L.,Ottawa Hospital Rehabilitation Center | Uhthoff H.K.,University of Ottawa
Journal of Applied Physiology | Year: 2014

Joint contractures alter the mechanical properties of articular and muscular structures. Reversibility of a contracture depends on the restoration of the elasticity of both structures. We determined the differential contribution of articular and muscular structures to knee flexion contractures during spontaneous recovery. Rats (250, divided into 24 groups) had one knee joint surgically fixed in flexion for six different durations, from 1 to 32 wk, creating joint contractures of various severities. After the fixation was removed, the animals were left to spontaneously recover for 1 to 48 wk. After the recovery periods, animals were killed and the knee extension was measured before and after division of the transarticular posterior muscles using a motorized arthrometer. No articular limitation had developed in contracture of recent onset (≤2 wk of fixation, P > 0.05); muscular limitations were responsible for the majority of the contracture (34 ± 8° and 38 ± 6°, respectively; both P ± 0.05). Recovery for 1 and 8 wk reversed the muscular limitation of contractures of recent onset (1 and 2 wk of fixation, respectively). Long-lasting contractures (≥4 wk of fixation) presented articular limitations, irreversible in all 12 durations of recovery compared with controls (all 12 P < 0.05). Knee flexion contractures of recent onset were primarily due to muscular structures, and they were reversible during spontaneous recovery. Long-lasting contractures were primarily due to articular structures and were irreversible. Comprehensive temporal and quantitative data on the differential reversibility of mechanically significant alterations in articular and muscular structures represent novel evidence on which to base clinical practice. Copyright © 2014 the American Physiological Society.


Murray M.A.,University of Ottawa | Stacey D.,University of Ottawa | Wilson K.G.,Ottawa Hospital Rehabilitation Center | O'Connor A.M.,University of Ottawa
Journal of Palliative Care | Year: 2010

The effect of a program to train clinicians to support patients making decisions about place of end-of-life care was evaluated. In all, 88 oncology and/or palliative care nursing and allied health providers from three Ontario health networks were randomly assigned to an education or control condition. Quality of decision support provided to standardized patients was measured before and after training, as were participants' perceptions about the acceptability of the training program and their intentions to engage in patient decision support. Compared to controls, intervention group members improved the quality of decision support provided and were more likely to address a wider range of decision-making needs. Intervention group members scored higher on a knowledge test of decision support than controls and rated the components as acceptable. Improvements in the quality of decision support can be made by providing training and practical tools such as a patient decision aid.


Quon D.L.,Ottawa Hospital Rehabilitation Center | Dudek N.L.,Ottawa Hospital Rehabilitation Center | Marks M.,Ottawa Hospital Rehabilitation Center | Boutet M.,University of Ottawa | Varpio L.,University of Ottawa
Journal of Bone and Joint Surgery - Series A | Year: 2011

Background: Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process. Methods: Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified. Results: Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patient's expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation. Conclusions: The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others' opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome. Clinical Relevance: Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.


Kowal J.,Ottawa Hospital Rehabilitation Center | Kowal J.,University of Ottawa | Wilson K.G.,Ottawa Hospital Rehabilitation Center | Wilson K.G.,University of Ottawa | And 3 more authors.
Pain | Year: 2012

Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual's chronic pain, none have examined patients' perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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