Papers by Anouk Lamontagne
PLOS ONE, Apr 12, 2023
The objective was to explore the care experiences and service design related to rehabilitation fo... more The objective was to explore the care experiences and service design related to rehabilitation for mobility and participation in the community among individuals with acquired brain injury (ABI), as perceived by clinicians and patients. Five focus groups were held: three with clinicians and two with individuals with ABI. Focus group discussions were transcribed and analyzed using an inductive and deductive thematic content approach. Five themes were identified: Enabling continuity of care; System design; Accessibility and services in the community; Transportation services; and Uncertainty about the provided services. The results of participants’ experiences contributed to developing recommendations of service provision for mobility, leading to a patient-centered continuum of rehabilitation services. Accessibility to rehabilitation to improve the quality of care by addressing needs during transitions and mobility-related deficits, providing needed information, coordinated care, and self-management support in the community.
Background: Virtual reality (VR) is increasingly being incorporated into research and clinical pr... more Background: Virtual reality (VR) is increasingly being incorporated into research and clinical practice. Its usefulness, however, remains largely dependent on the extent to which it elicits human behaviors that are similar to those observed in the real world. Objectives: In this study, we estimated whether obstacle avoidance strategies while walking in response to pedestrians approaching from different directions differed when performed in a virtual (VE) vs. physical environment (PE). We also examined the extent to which avoidance strategies in the VE change with repeated practice. Methods: Participants (n=4) were assessed while walking overground and avoiding moving pedestrians in both a VE and a PE, in a random order. Three female collaborators acted as interferers in the PE experiment. For the VE experiment, we created avatars using full body kinematics recorded from the actors. The task consisted of walking towards a target while avoiding one of the interferers, which could approach from either the left or right side (±30°), or from the center (0°). In a fourth condition, all interferers walked away (no obstacle). Results: Delayed onset times of avoidance strategy and slower walking speeds were observed in the VE vs. PE. With practice in the VE, there was a progressive decrease in onset time of avoidance strategy and an increase in walking speed. Differences between the two environments, however, persisted by the end of the experiment. Maximal trajectory deviation and distance at onset of avoidance strategy remained comparable between the VE and PE throughout the experiment. Conclusion: Obstacle avoidance behavior in response to moving pedestrians differs in the VE vs. PE, although spatial parameters (e.g. distance at the onset and maximum lateral deviation) appear to be similar. Differences decrease but remain present despite of repeated exposure to the VE. Results should be taken into consideration when using the VR technology for assessment or training purposes.
Clinical Neurophysiology, Oct 1, 2010
patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait distu... more patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait disturbance such as hemiparetic gait and ataxic gait was characterized by the combination of asymmetrical activities in the medial motor related areas, recruitment of premotor cortex and prefrontal cortex, and abnormal time-course of oxygenated hemoglobin signals during sustained gait. Improved gait performance after rehabilitative intervention was related to improvement of these abnormal signal patterns and/or augmented signals in the motor related areas. Cortical activities during postural control were also modified by these diseases. Recent data have suggested that the prefrontal cortex plays an important role in controlling balance in healthy subjects and patients with cerebral and cerebellar lesions. Supported by Grant-in-Aid for “the Research Committee for Ataxic Diseases” of Research on Measures for Intractable Diseases & Research Grant (21B-9) for Nervous and Mental Disorders.
Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been... more Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been strongly associated with poor functional outcomes in self-care and instrumental activities of daily living. Hence, its sensitive detection is crucial. Yet, conventional USN assessments present with significant limitations, often leading to misdiagnosis. Virtual reality (VR) can be used to counteract those issues and increase detection sensitivity. Objective: To examine the feasibility, refine development and promote future implementation of a novel Ecological VR-based Evaluation of Neglect Symptoms (EVENS). Methods: EVENS consists of two (simple and complex) immersive, 3-D scenes, depicting grocery shopping shelves, where object-detection and navigation tasks are performed using a joystick. Through a cross-sectional study, the effects of virtual scene complexity on navigational and detection abilities in patients with (USN+) and without (USN−) post-stroke USN and in healthy controls (HC) were determined. These findings were complimented by gathering the opinion of clinicians and experts in the field as to the barriers/facilitators to the use of VR and the features for an optimal assessment. Results: Longer detection times and larger mediolateral deviations from ideal paths were found in USN+ vs. USN− and HC groups. Several barriers/facilitators for clinical VR use and features of an optimal VR-based tool were identified. Conclusion: Navigation and detection abilities are affected by environmental complexity of the VR scene in individuals with post-stroke USN and can be employed for USN assessment. The present knowledge translation initiatives can refine EVENS' design and promote its future application and adherence to its use in clinical settings.
Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial ... more Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial task for young adults, but with age or for stroke survivors it can become a daunting endeavour. Coordinated eye-head movements probably play an important role in obstacle circumvention, but unfortunately the literature on the subject is rather scarce. Objectives: The aim of this study was therefore to investigate eye-head coordination during overground locomotion, and, more specifically, during avoidance of dynamic virtual pedestrians. Methods: We recorded eye (ASL eyetracker ) and body (Vicon system) movements in five healthy young adults during overground locomotion as they navigated in a virtual environment visualized in a helmet mounted display. Medio-lateral (ML) displacements as well as the pattern of eye, head and gaze reorientation in the horizontal plane were examined. Participants were instructed to walk toward a goal represented by a blue target located 9.5m straight ahead and to avoid a non-reactive human-like avatar coming from different angles of approach. Results: We found that ML trajectory displacements were preceded by a head rotation in the direction of veering. Halfway through the ML head displacement, a head rotation in the direction opposite to that of the ML displacement was observed. Head rotations were themselves preceded by eye saccade(s) toward the side of circumvention. During the circumvention, no attempt was made to keep the head in alignment with the goal. Conclusions: Eye/gaze movements appear to play an important role during the avoidance of dynamic obstacles while walking. Eye movements are initiated ahead of the trajectory ML displacement, possibly to localize the obstacle and/or plan the future walking trajectory.
Neuroscience Letters, Sep 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Frontiers in virtual reality, Mar 23, 2023
Annals of Medicine, 2021
Abstract Objectives To identify factors which may influence mobility and could be considered duri... more Abstract Objectives To identify factors which may influence mobility and could be considered during the evaluation of mobility in individuals with acquired brain injury (ABI) following qualitative focus groups with both clinicians and individuals with ABI, to assess their needs and preferences in order to individualize their care management plans. Methods Five focus groups were held, three with clinicians from 3 rehabilitation sites of CRIR (CRDM: n = 4; IURDPM: n = 3; JRH: n = 10) and two with individuals with ABI from one rehabilitation site (CRDM) (individuals with stroke: n = 5; individuals with TBI: n = 5). Focus group discussions were transcribed and analyzed using inductive and deductive thematic content approaches. Results Four themes were identified: considering mobility holistically and individual needs, preferences, and unique experiences; assessment and intervention guidelines; support network; and uncertainty about symptoms and recovery. Using the ten-rule International Classification, Functioning, Disability, and Health framework linking process, codes were categorized into Body Functions Activity and Participation, and Environmental Factors exploring the prominent domains that mostly identify factors influencing mobility. Conclusions Comprehensive measurement of mobility remains an ongoing challenge owing to multiple contributing factors, ranging from personal and psychosocial factors to the influence of a myriad of environmental and community considerations. Preparing individuals with ABI for community mobility can be substantially improved if healthcare professionals employ communicative tools to facilitate shared decision making with patients and to deliver patient-centred rehabilitation care.
Theoretical Issues in Ergonomics Science, 2021
A model of Multiple Resource Theory (MRT) was created to describe the influence of different conc... more A model of Multiple Resource Theory (MRT) was created to describe the influence of different concurrent tasks on driving but no such framework exists for DT walking. The objective of this study was to modify MRT model and computational DT framework to explore two task-related concepts—resource demand and resource conflict—in the context of gait and to illustrate the initial validity of the modified model. A literature search was conducted to identify DT walking-related elements related to the MRT model. An instructional guide for utilizing the computational framework was constructed using a modified e-Delphi method. Inter-rater reliability of the constructed guideline was analyzed by Kappa statistics. The initial validity of the modified model was tested using meta-regression analyses. Three new elements were included into the modified model: vestibular and somatosensory perceptions, and locomotor response. The spatial code from the original model was modified into a visuospatial domain. The computational framework was constructed, and two separate guidelines were created for walking and concurrent tasks. Using the guidelines and computational framework, task-related elements were quantified for meta-regression analysis. The analysis showed that the modified model can explain 79% of the variability in speed reduction during DT walking.
Annals of Physical and Rehabilitation Medicine, 2018
Pediatric Physical Therapy, 2016
To compare results of 3 clinical vestibular tests between children with global developmental dela... more To compare results of 3 clinical vestibular tests between children with global developmental delay (GDD) and children with typical development (TD) and investigate the test-retest reliability. Twenty children with GDD (aged 4.1-12.1 years) and 11 age-matched controls with TD participated. Participants with GDD underwent 2 sessions of testing. Each session consisted of the Clinical Test of Sensory Interaction and Balance (CTSIB), Dynamic Visual Acuity (DVA) test, and the modified Emory Clinical Vestibular Chair Test (m-ECVCT). Up to 33% of the children with GDD had abnormal DVA scores. m-ECVCT results of children with GDD demonstrated larger variance than children with TD. The CTSIB score was significantly reduced in the group with GDD. The test-retest reliability varied, with good reliability for the m-ECVCT and CTSIB, and fair reliability for the DVA. Findings suggest vestibular involvement in children in GDD. The clinical tests demonstrated moderate test-retest reliability.
Journal of Neuroengineering and Rehabilitation, Jun 15, 2017
Background: Locomotor strategies for obstacle circumvention require appropriate postural coordina... more Background: Locomotor strategies for obstacle circumvention require appropriate postural coordination that depends on sensorimotor integration within the central nervous system. It is not known how these strategies are affected by a stroke. The objective of this study was to contrast postural coordination strategies used for obstacle circumvention between post-stroke participants (n = 12) and healthy controls (n = 12). Methods: Participants walked towards a target in a virtual environment (11 × 8 m room) with cylindrical obstacles that were stationary or approaching from head-on, or diagonally 30°left/right. Results: Two stepping strategies for obstacle circumvention were identified: 1) side step: increase in step width by the foot ipsilateral to the side of circumvention; 2) cross step: decrease in step width by the foot contralateral to the side of circumvention. The side step strategy was favoured by post-stroke individuals in circumventing stationary and head-on approaching obstacles. In circumventing diagonally approaching obstacles, healthy controls generally veered opposite to obstacle approach (>60% trials), whereas the majority of post-stroke participants (7/12) veered to the same side of obstacle approach (V same). Post-stroke participants who veered to the opposite side (V opp , 5/12) were more independent and faster ambulators who favoured the side step strategy in circumventing obstacles approaching from the paretic side and cross step strategy for obstacles approaching from the non-paretic side. V same participants generally favoured the side step strategy for both diagonal approaches. Segmental rotation amplitudes and latencies were largest in the V same group, and significantly greater in post-stroke participants than controls for all obstacle conditions. All participants initiated circumvention with the feet followed by the pelvis and thorax, demonstrating a caudal-rostral sequence of reorientation. Conclusion: Postural coordination strategies for obstacle circumvention were altered post stroke, depending on the residual or restored functional abilities. Segmental reorientations are also affected by the motion and direction of obstacle.
Gait & Posture, Feb 1, 2020
BACKGROUND Reading text messages is associated with accidents while walking in community places. ... more BACKGROUND Reading text messages is associated with accidents while walking in community places. RESEARCH QUESTION To what extent does reading text messages at different stages of obstacle circumvention affect avoidance strategies while walking in young vs. older adults? METHODS Sixteen healthy young and 14 older adults were assessed while walking and viewing a virtual environment (VE) simulating a subway station with three virtual pedestrians positioned 7.5 m away from the participant in the centre (0°), left and right (±40°). As participants advanced 0.5 m towards a target in the far space, a virtual pedestrian randomly approached them. Text messages were delivered at onset of pedestrian movement (0.5 m; early message) or during obstacle circumvention (2.5 m; late message). A Vicon motion capture system captured trajectory displacement while walking. RESULTS In both age groups, accuracy of message report (AMR) was reduced for early compared to late messages (p < 0.001), although older adults showed larger deterioration (p < 0.001) compared to younger participants. Locomotor outcomes (obstacle clearance, onset time of avoidance and walking speed) showed no differences between young and older participants (p > 0.05). Early messages led to slower walking speed (p < 0.001) and more frequent collisions compared to late messages and the no-message condition. Late messages yielded faster walking speed (p < 0.001) and onset time of avoidance (p < 0.02) compared to the other conditions. SIGNIFICANCE Results indicate that the stage of an avoidance strategy at which text messages are received impacts on pedestrian circumvention, with early messages posing a greater challenge to collision avoidance. In older adults, the reduced AMR suggests larger dual-task interference and prioritization of the walking task. The lack of further walking speed reduction in older vs. young adults may put them at greater risk of collisions in crowded, unpredictable community environments.
Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait re... more Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait rehabilitation interventions and negatively affects functional mobility. This pilot study examines the feasibility and instantaneous effects of real-time visual feedback provided in the form of a virtual avatar replicating on gait symmetry after stroke. Based on the results obtained from one chronic stroke survivor, step length and step time ratios were improved towards normal values (1.0) in presence of the avatar displayed in a third person back and paretic side view, while mixed results were observed for the front view condition. Gains were not maintained following the removal of the avatar. These preliminary results, to be confirmed in a larger sample of participants, support the feasibility of using virtual avatars as a source of visual feedback to promote gait symmetry in stroke survivors.
Journal of Neurophysiology, May 1, 2012
Most falls in older adults occur when walking, specifically following a trip. This study investig... more Most falls in older adults occur when walking, specifically following a trip. This study investigated the short-and longer term responses of young (n ϭ 24, 27.6 Ϯ 4.5 yr) and older adults (n ϭ 18, 69.1 Ϯ 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (Ͼ25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 Ϯ 0.7 cycles; young, 2.88 Ϯ 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, Ϫ83°to Ϫ90°; young, Ϫ39°to Ϫ42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults. perturbation; aging; falls; arms; balance FALL-RELATED INJURY in older adults places a heavy burden on the health care system with over 19 billion dollars spent in direct medical costs in the U.S. in 2000 alone (Stevens et al. 2006). Identification of mechanisms leading to falls or to recovery from falls in older adults can assist in fall prevention because it can lead to more effective interventions (Chang et al. 2004). Most falls in older adults occur when walking (Berg et al. 1997; Nevitt et al. 1991) due to tripping (34%) or slipping (25%). The fact that young adults rarely fall during walking suggests that gait stability is affected by aging. Gait stability can be defined as the ability to maintain functional locomotion despite perturbations (England and Granata 2007
Background: Individuals who have sustained a stroke can manifest altered locomotor steering behav... more Background: Individuals who have sustained a stroke can manifest altered locomotor steering behaviors when exposed to optic flows expanding from different locations. Whether these alterations persist in the presence of a visible goal and whether they can be explained by the presence of a perceptuo-motor disorder remain unknown. The purpose of this study was to compare stroke participants and healthy participants on their ability to control heading while exposed to changing optic flows and target locations. Methods: Ten participants with stroke (55.6 ± 9.3 yrs) and ten healthy controls (57.0 ± 11.5 yrs) participated in a mouse-driven steering task (perceptuo-motor task) while seated and in a walking steering task. In the seated steering task, participants were instructed to head or 'walk' toward a target in the virtual environment by using a mouse while wearing a helmet-mounted display (HMD). In the walking task, participants performed a similar steering task in the same virtual environment while walking overground at their comfortable speed. For both experiments, the target and/or the focus of expansion (FOE) of the optic flow shifted to the side (±20°) or remained centered. The main outcome measure was net heading errors (NHE). Secondary outcomes included mediolateral displacement, horizontal head orientation, and onsets of heading and head reorientation. Results: In the walking steering task, the presence of FOE shifts modulated the extent and timing of mediolateral displacement and head rotation changes, as well as NHE magnitudes. Participants overshot and undershot their net heading, respectively, in response to ipsilateral and contralateral FOE and target shifts. Stroke participants made larger NHEs, especially when the FOE was shifted towards the non-paretic side. In the seated steering task, similar NHEs were observed between stroke and healthy participants. Conclusions: The findings highlight the fine coordination between rotational and translational steering mechanisms in presence of targets and FOE shifts. The altered performance of stroke participants in walking but not in the seated steering task suggests that an altered perceptuo-motor processing of optic flow is not a main contributing factor and that other stroke-related sensorimotor deficits are involved.
Journal of Clinical Medicine, Feb 22, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Through the lens of a Rehabilitation Living Lab, this paper presents what happens when researcher... more Through the lens of a Rehabilitation Living Lab, this paper presents what happens when researchers work with managers and users in the design situation of an urban commercial complex. This multi-sectorial and interdisciplinary research project brings together over 45 researchers to explore issues of social inclusion and social participation of people with disabilities, as they arrive and use the shopping complex. Within the context of a Living Lab, researchers implement various research projects from diverse research paradigms and methodological perspectives. While the research method for the overarching project is within the general framework of participatory action research, all researchers use clinical, basic and experimental forms of research (Friedman, 2003) to move forward the goals and research streams defined at the outset. The research is supported by a parallel design activity with students in a baccalaureate design studio. The overall research project goals and an example of a pilot project are presented in concert with a design studio activity, to consider potential concepts that are research-informed. Discussion of results reveals salient issues that emerge in early findings in pilot studies, and underscores what happens when people from diverse research perspectives work together.
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Papers by Anouk Lamontagne