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PubMed2001

Effect of stroke on step characteristics of obstacle crossing.

OBJECTIVE: To compare spatial and temporal measures during lead limb obstacle crossing between subjects with stroke and healthy subjects. DESIGN: Experimental, observational, with matched controls. SETTING: Geriatric rehabilitation unit in a tertiary referral hospital. PARTICIPANTS: Distance data were available for 19 subjects with stroke and 19 able-bodied subjects. Temporal data were available for 16 subjects with stroke and 16 able-bodied subjects. Subjects with stroke were inpatients and had to be able to walk 10 meters without assistance or gait aid. INTERVENTION: Subjects were required to step over high and wide obstacles, ranging from 1 to 8cm, and trials were videotaped. MAIN OUTCOME MEASURES: Toe clearance, preobstacle distance, postobstacle distance, step length, proportion of step length preobstacle, step time, preobstacle step time, postobstacle step time, and proportion of step time preobstacle were measured. RESULTS: Mann-Whitney U tests were performed to determine differences between the 2 groups. Subjects with stroke had significantly higher toe clearance, smaller postobstacle distances, and greater step times than healthy subjects. Subjects with stroke did not demonstrate a significant reduction in preobstacle distance. CONCLUSION: By modifying their lead limb trajectory during obstacle crossing, persons with stroke reduce the risk of a trip due to toe contact, but the modification may expose them to other safety risks.

Aged↗
PubMed2004

Social capital, participation and the perpetuation of health inequalities: obstacles to African-Caribbean participation in 'partnerships' to improve mental health.

OBJECTIVES: There has recently been much emphasis on the role of 'partnerships' between local community 'stakeholders' in strategies to redress health inequalities. This paper examines obstacles to participation in such partnerships by African-Caribbean lay people in local initiatives to improve mental health in a town in southern England. We present a 'social psychology of participation' which we use to interpret our data. Our work seeks to illustrate some of the micro-social mechanisms through which social inequalities are perpetuated, using Bourdieu's conceptualization of the role played by various forms of capital (economic, social, cultural and symbolic) in perpetuating social inequalities. DESIGN: Our empirical research consists of a qualitative case study of attitudes to participation in mental-health-related partnerships in a deprived community. In-depth interviews and focus groups were conducted with 30 local community 'stakeholders', drawn from the statutory, voluntary, user and lay sectors. RESULTS: While interviewees expressed enthusiasm about the principles of participation, severe obstacles to its effective implementation were evident. These included severe distrust between statutory and community sectors, and reported disillusionment and disempowerment within the African-Caribbean community, as well as low levels of community capacity. Moreover, divergent understandings of the meaning of 'partnership' suggested that it would be difficult to satisfy both community and statutory sectors at once. CONCLUSIONS: We suggest that disadvantaged and socially excluded communities are often deprived of the social resources which would provide a solid basis for their participation in partnerships with state health services. In the absence of efforts to remove such obstacles, and to generate the necessary resources for participation, partnerships may be 'set up to fail', leaving social inequalities to prevail.

Adolescent↗
PubMed2000

Obstacles to a randomised controlled trial of intensive dynamic psychotherapy: an account of the New South Wales Section of Psychotherapy outcomes project.

OBJECTIVE: This paper examines the obstacles to a randomised controlled trial (RCT) of intensive dynamic psychotherapy (IDP) by reference to the fate of the New South Wales Section of Psychotherapy outcomes project. METHOD: Planning was complete and the final research protocol was about to be implemented when funding difficulties led to suspension of the project. The opinions of the research subcommittee regarding the main obstacles to the ultimate success of the project are now analysed in the expectation that better research strategies will follow. RESULTS: With hindsight, six of the eight members of the research subcommittee reported that the project was not feasible. By choice of questionnaire items they identified the greatest threats to a successful trial as: standardisation of the procedures, termination at 24 months, the availability of funding and the choice of treatment procedures. The most frequently volunteered concerns related to the enlistment and cooperation of the trial therapists (5), standardisation of the experimental therapy (3), probable shortfall in trial subjects (3) and the availability of funding (2). CONCLUSIONS: The most powerful general obstacles to success of the project related to the standardisation of procedures and the failure to maintain sufficient cooperation of trial therapists. The protocol required IDP therapists to terminate procedures at 24 months, which contradicted their usual practices and led to some alienation from the project. Amendments to the protocol might improve the possibility of a successful trial. However, one might also conclude that it is premature to attempt a naturalistic RCT of IDP.

Adult↗
PubMed2002

Interest in and obstacles to pursuing work among unemployed dually diagnosed individuals.

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N= 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.

Adult↗
PubMed2003

Attitudes and beliefs about 12-step groups among addiction treatment clients and clinicians: toward identifying obstacles to participation.

Participation in 12-step groups (12SG) during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12SG may be limited by high attrition rates and by low participation, areas on which there has been little research. Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians' attitudes about 12-step groups or about their experiences in referring clients. This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between May, 2001 and January, 2002 in New York City. Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years. Both staff and clients viewed 12SG as a helpful recovery resource. Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness). Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12SG. Clinical implications of these findings are discussed, including the importance of fostering motivation for change, the need to assess clients' beliefs about and experiences with 12SG on a case-by-case basis, and to find a good fit between clients' needs and inclinations on the one hand, and the tools and support available within 12-step groups on the other.

Black or African American↗
PubMed2006

Obstacle clearance and prevention from falling in the bipedally walking Japanese monkey, Macaca fuscata.

BACKGROUND: studies are needed which consider CNS-controlled strategies for accommodating perturbed bipedal (Bp) posture and walking. OBJECTIVE: to demonstrate the suitability of the Japanese monkey, Macaca fuscata, for the above purpose. SETTING AND SUBJECTS: three adult monkeys were operantly trained to use Bp-walking on a moving treadmill belt. On one side of the belt, a rectangular adjustable-height obstacle confronted the ipsilateral leg every 4-6 steps, as determined by belt speed. METHODS: animal posture and walking patterns were captured and digitized by two high-speed video systems. Frame-by-frame analyses of side- and back-view kinematics were obtained. RESULTS: the monkeys learned quickly to proactively clear the in-coming obstacles by use of a flexible hip-knee-ankle flexion strategy. This featured an appropriate postural adjustment and leg trajectory. In cases where a monkey failed to clear the obstacle, it promptly adopted a defensive posture to avoid falling. There was then a quick return to a posture that allowed the resumption of a Bp gait. CONCLUSIONS: when Bp posture and gait are perturbed in a non-human primate model, the prompt adjustment of a flexible hip-knee-ankle flexion strategy and a defensive postural adjustment act together to prevent a fall and enable the speedy resumption of normal Bp posture and gait.

Accidental Falls↗
PubMed1995

Psychological obstacles to job or career change in late life.

Four studies involving middle-aged and older workers were conducted to (a) explore perceived obstacles to adaptive job or career changes in later-life, and (b) develop an instrument with which to identify older adults who might be more sensitive to such obstacles. A reliable instrument was developed which reflected three broad categories of perceived risk: (a) age-inappropriateness of the change, (b) potential for age-discrimination, and (c) risk of hastened obsolescence. As evidence for the convergent validity of the instrument, the results indicated a heightened sensitivity to job change obstacles among respondents with: (a) age-sensitized concerns about job and financial security, (b) poorer psychological adjustment to a plateaued career, and (c) poorer psychological and social adjustment to their own aging.

Age Factors↗
PubMed2002

Obstacles to palliation and end-of-life care in a long-term care facility.

PURPOSE: This exploratory study used a set of four obstacle constructs derived from both the existing literature and our earlier work to describe the diverse end-of-life scenarios observed for a group of residents in a long-term care facility. DESIGN AND METHODS: Data from a retrospective chart review and both quantitative and qualitative methods of data collection and analysis were used to examine in-depth the end-of-life experiences of all nursing home residents (N = 41) who died on the nursing care unit of a large continuing care retirement community during an 18-month period. RESULTS: A hierarchy of obstacles to palliation and end-of-life care seems to exist in long-term care settings that begins with the lack of recognition that restorative, rehabilitative, or curative treatment futility has commenced. The next three obstacles in sequence include lack of communication among decision makers, no agreement on a course of care, and failure to implement a timely plan of care. IMPLICATIONS: The findings highlight the importance of determining treatment futility as an initial step in the successful delivery of palliative and end-of-life care to residents in long-term care followed by the need for a deliberate and proactive series of actions and care planning processes.

Advance Directives↗
PubMed2001

Obstacles to influenza immunization in primary care.

BACKGROUND: General practices undertake annual immunization campaigns to protect susceptible patients against influenza. Many practices, however, do not adopt effective approaches and there is great variation in the immunization rates achieved. This study aimed to assess the attitudes of primary care staff to the annual immunization programme, the obstacles they face, and possible reasons for the wide variation in immunization rates. METHOD: A semi-structured questionnaire survey of general practice groups in Salford &Trafford during winter 1997-1998 was carried out, a total of 104 practices. RESULTS: Respondents perceived influenza vaccine to be effective (93.2 per cent), well received by patients (91.7 per cent) and without significant side-effects (83.6 per cent). The annual immunization programme was seen as being necessary (91.8 per cent), cost-effective (76.7 per cent), reducing hospital admissions (82.2 per cent), but very time consuming (64.4 per cent). Practices were more likely to target patients specified in the Chief Medical Officer's guidelines; however, most (98.6 per cent) targeted the over-75s before their inclusion in the guidelines, and many (61.6 per cent) targeted the over-65s. Practices did not always use the most effective methods of contacting patients, primarily relying on posters (97.3 per cent), opportunistic contacts (95.9 per cent) and reminders on prescriptions (83.6 per cent), rather than letters (39.7 per cent) and telephone calls (11.0 per cent). Practices identified several common obstacles to immunization, relating to the cost and administrative burden of the annual immunization programme, difficulty identifying high-risk patients, and public beliefs about influenza and influenza vaccine. CONCLUSIONS: Although generally positive towards influenza immunization, practice staff differ in their ability to cope with, and the appropriateness of their response to, the pressures of the annual immunization programme. Additional support and co-operation from the Department of Health, Health Authorities and pharmaceutical companies could remove some of the obstacles to immunization of high-risk patients.

Age Factors↗
PubMed1981

Objective obstacles in hiring disabled persons -- the employers' point of view.

In the comprehensive rehabilitation process, one of the most accepted criteria for success or failure is the suitable placement of the client in the open employment market. The present study examined employer's attitudes toward hiring disabled persons. The sample consisted of 233 employers in the public and private sectors of the Israeli economy, and the method entailed interviewing each employer about his attitudes toward the risks of employing disabled persons, his actual hiring practices, and his expected response to financial aid for surmounting technical obstacles (architectural barriers and inappropriate work methods and tools). Interpretation of the results indicated that employers' reluctance to hire disabled employees was often explained by the existence of technical obstacles. However, when the possibility of financial aid for eliminating these obstacles was proposed, the employers responded with reservation. Although Israeli has mandated legislation requiring the employment of disabled war veterans, not all employers were aware of this, and almost half of those who were did not employ disabled persons. Evidently, legislation does not suffice in order to ensure actual hiring of disabled persons. In order to increase compliance with the law, and to encourage hiring of disabled persons who are not war veterans, it was suggested that more information be provided to the employers on the possibilities of employing disabled persons, with emphasis placed on the positive aspects of the disabled worker's true potential. Additional methods that should be applied to encourage employment include appropriate vocational training of disabled persons themselves and demonstration before the employers of the practical conditions under which successful employment is possible.

Architectural Accessibility↗
PubMed2005

Reliability and construct validity studies of an obstacle course assessment of wheelchair user performance.

The objective of this study is to evaluate the reliability and construct validity of an obstacle course assessment of wheelchair user performance (OCAWUP). Seventeen experienced wheelchair users using three different propulsion methods (two hands, one hand and one foot or motorized wheelchair) were assessed twice on the 10 obstacles of the OCAWUP. To evaluate reliability, time (in seconds) and degree of ease (DE) in overcoming obstacles (four-level scale) were assessed by three occupational therapists. Construct validity was assessed by verifying whether the OCAWUP's global score of ease (GSE) varied with wheelchair propulsion methods and the functional independence measure (FIM). Intraclass correlation coefficients calculated for reliability of time and GSE were up to 0.74 for test-retest reliability and up to 0.97 for interrater reliability. Cohen's kappa coefficients calculated for DE reliabilities varied from 0.09 to 1.0 with degrees of association up to 65%. A significant difference (P<or =0.01) in GSE scores is shown between propulsion methods. A high significant correlation (rs=0.84, P< or =0.05) was found between GSE and scores of FIM items associated with mobility. Reliability of time and GSE is substantial or better. Reliability of DE is not as good, with a few items indicating poor reliability. OCAWUP's construct validity is good.

Acceleration↗
PubMed2003

Clinical trials in rehabilitation: what are the obstacles?

Across rehabilitation, there is a shortage of treatments that have demonstrated efficacy and effectiveness through rigorously controlled clinical trials. Although rehabilitation efficacy and effectiveness research present many of the obstacles that are found in research on other biomedical domains, they also present a number of obstacles that are specific to the conceptual framework underlying rehabilitation practice. In this article, I review the specific challenges presented by the need to rigorously define the research participants, the treatment under investigation, and the outcomes by which treatment response will be measured. I also suggest research that will be necessary to surmount some of these obstacles.

Evidence-Based Medicine↗
PubMed2004

Obstacle avoidance for kinematically redundant manipulators using a dual neural network.

One important issue in the motion planning and control of kinematically redundant manipulators is the obstacle avoidance. In this paper, a recurrent neural network is developed and applied for kinematic control of redundant manipulators with obstacle avoidance capability. An improved problem formulation is proposed in the sense that the collision-avoidance requirement is represented by dynamically-updated inequality constraints. In addition, physical constraints such as joint physical limits are also incorporated directly into the formulation. Based on the improved problem formulation, a dual neural network is developed for the online solution to collision-free inverse kinematics problem. The neural network is simulated for motion control of the PA10 robot arm in the presence of point and window-shaped obstacle.

Journal Article↗
PubMed2005

Obstacles and solutions for spontaneous reporting of adverse drug reactions in the hospital.

AIM: To describe the opinions of hospital physicians concerning problems regarding the spontaneous reporting of adverse drug reactions (ADRs) and ways to solve them. METHODS: A qualitative study was carried out. Fifteen focus groups were conducted among physicians working in a tertiary teaching hospital. A total of 208 physicians from different medical specialities participated. The focus group discussions were recorded by three different observers and the transcripts of each session were analysed for issues and themes emerging from the text. RESULTS: Four types of obstacles to spontaneous reporting were considered particularly important: (i) problems with the ADR(S) diagnosis; (ii) problems with the usual workload and lack of time; (iii) problems related to the organization and activities of the pharmacovigilance system; (iv) and problems related to potential conflicts. The potential solutions suggested for improving spontaneous reporting were to define the kind of ADR(S) which should be reported, to facilitate an easy contact and quick access to the hospital pharmacovigilance system, to facilitate information and support for reporting and feedback of pharmacovigilance activities. CONCLUSIONS: The perception of the different obstacles by the hospital physicians is an important factor in determining the causes of the underreporting of ADRs and addressing these obstacles could lead to an improvement in spontaneous reporting. A closer relationship between the doctors and the pharmacovigilance centre is suggested as a means of solving these problems. More information is needed to improve the spontaneous reporting of ADR(S) in specialized healthcare.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Obstacles in large-scale epidemiological assessment of sensory impairments in a Dutch population with intellectual disabilities.

BACKGROUND: A population-based epidemiological study on visual and hearing impairment was planned in a random sample of 2100 clients, drawn from a base population of 9012 users of Dutch residential and day-care intellectual disability (ID) services with the whole range of IDs. Stratification was applied for age 50 years and over and Down syndrome. Visual and hearing functions were assessed according to a standardized protocol, in cooperation with regular ophthalmologists and regional audiological centres. Anticipated obstacles in sample collection, random inclusion, informed consent, expertise of investigators, time and costs were eliminated by a careful preparation. However, inclusion and participation were incomplete. METHOD: In a descriptive retrospective design, we collected data from our study files on inclusion and participation as well as reasons for non-participation, to identify unanticipated obstacles for this kind of research. RESULTS: Consent was obtained for 1660 clients, and 1598 clients participated in the data collection (76% of intended sample of 2100). Inclusion and participation rates were especially lower in community-based care organizations, resulting in unintentional skewing of the sample towards more severe levels of ID. Complete and reliable data to diagnose visual impairment were obtained for 1358/1598 (85%) and to diagnose hearing impairment for 1237/1598 participants (77%). Unanticipated obstacles had to do with the quality of coordination within care organizations, with characteristics of screening methods, and with collaboration with the regular health care system. Assessments of visual function were more easy to organize than were those of hearing. Based on our current experience, practical recommendations are given for future multicentre research, especially in community-based settings.

Adolescent↗
PubMed2001

Obstacle avoidance during human walking: learning rate and cross-modal transfer.

1. The aim of this study was to investigate the significance of specific afferent information during motor learning. Blindfolded subjects stepped over an obstacle on a treadmill while different stimuli (acoustic (ACU), somatosensory (SOM) and light flash (LED)) signalled the approaching obstacle. The effect of the above stimuli was then evaluated and compared to full vision (VIS) locomotion. In the non-visual conditions feedback information about the performance was provided by an acoustic signal. 2. Using each of the different stimuli for information the level of subject performance was assessed by noting foot clearance and analysing both leg muscle electromyographic activity and movement trajectories during three successive runs. Each of these runs consisted of 100 steps over the obstacle. 3. The best performance at the onset of the first run was achieved during the VIS condition. When the VIS condition (run 1 + 2) was followed by ACU or SOM information or when the ACU condition (run 1 + 2) was followed by LED, little cross-modal transfer (CMT) occurred, i.e. adaptation in run 3 started again at a low level of performance. In contrast, if adaptation started with ACU stimuli followed by SOM stimuli, almost full CMT occurred. The absolute level of performance achieved after the second or third runs was similar in the VIS and non-VIS conditions. 4. In conclusion, the course of motor learning depends on specific afferent information, and feedforward control has a special influence on the performance only at the onset of the experiment but not on the rate of learning. The fact that little CMT occurs from visual to non-visual stimuli and from ACU to LED suggests that visual afferent input is processed in a different way to non-visual stimuli.

Acoustic Stimulation↗
PubMed2001

Ability of blind people to detect obstacles in unfamiliar environments.

PURPOSE: To describe obstacle detection, sometimes called face vision, and blind peoples' lived experiences. DESIGN: This Husserlian phenomenologic inquiry included a convenience sample of eight blind participants who possessed the ability to detect obstacles in unfamiliar environments. METHODS: Face-to-face conversations were audiotaped in a setting of the participant's choice. FINDINGS: Three themes were identified: "a sense that something is there," "sensing," and "space." These three entwined themes were recognized in the unity-of-meaning or uniting theme: sensing presence as open or closed space. CONCLUSIONS: The findings of this study indicate many questions for nurses. Given the synergistic recognition of obstacles that the participants described, secondary analysis of the data is indicated, for example regarding pattern recognition and human environmental field integrality.

Activities of Daily Living↗
PubMed2000

A new formalism for time-dependent wave scattering from a bounded obstacle

A time-dependent three-dimensional acoustic scattering problem is considered. An incoming wave packet is scattered by a bounded, simply connected obstacle with locally Lipschitz boundary. The obstacle is assumed to have a constant boundary acoustic impedance. The limit cases of acoustically soft and acoustically hard obstacles are considered. The scattered acoustic field is the solution of an exterior problem for the wave equation. A new numerical method to compute the scattered acoustic field is proposed. This numerical method obtains the time-dependent scattered field as a superposition of time-harmonic acoustic waves and computes the time-harmonic acoustic waves by a new "operator expansion method." That is, the time-harmonic acoustic waves are solutions of an exterior boundary value problem for the Helmholtz equation. The method used to compute the time-harmonic waves improves on the method proposed by Misici, Pacelli, and Zirilli [J. Acoust. Soc. Am. 103, 106-113 (1998)] and is based on a "perturbative series" of the type of the one proposed in the operator expansion method by Milder [J. Acoust. Soc. Am. 89, 529-541 (1991)]. Computationally, the method is highly parallelizable with respect to time and space variables. Some numerical experiments on test problems obtained with a parallel implementation of the numerical method proposed are shown and discussed from the numerical and the physical point of view. The website: http://www.econ.unian.it/recchioni/w1 shows four animations relative to the numerical experiments.

Journal Article↗