All ETDs from UAB

Advisory Committee Chair

Christopher P Hurt

Advisory Committee Members

Cynthia J Brown

Amy W Amara

David C Knight

Suzanne E Perumean-Chaney

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Walking is a fundamental activity for one to interact effectively with one’s environment. Walking in the community often requires both a wide range and constant modification of walking speed. Decreased walking capacity, that is the maximum speed that a person can physically achieve, results in a decline in both functional mobility and personal independence, contributing to decreased community participation among individuals whose walking is impaired. The most common test of walking speed (i.e., overground comfortable and maximum walking speed) may not reflect the full capacity of individuals to regulate gait control. Whereas walking with progressively increasing treadmill speeds allows researchers and/or clinicians to assess potential factors that explain the walking capacity of an individual and better reflect a possible range of walking behavior in daily living. Many factors can influence walking including both physical and psychological limitations. Hence, understanding how factors may influence one another to negatively result in limited walking is important in designing walking interventions.However, few studies have investigated physical and psychological constraints while challenging participants to walk at faster walking speeds. Also, many measures that assess psychological function may not be dynamic enough to capture how these psychological factors are modified by progressively increasing treadmill speeds. The proposed research is thus fundamental to determine the extent to which physical and/or psychological constraints might influence individuals’ limited walking capacity while experiencing incrementally increasing walking speeds. This study developed dynamic measures of balance confidence and state anxiety that can assess perceptions to increasing walking speeds of older adults and individuals with neurodegenerative diseases such as Parkinson’s Disease (PD). These measures of balance confidence and state anxiety represented acceptable reliability and validity within a laboratory environment. Further, our walk speed test was able to differentiate individuals into completer and non-completer groups with many statistical differences. The results demonstrated limited walking capacity related with physical factors of dynamic stability and psychological aspects of balance confidence and state anxiety. Thus, it is recommended that evaluations of both physical and psychological factors should be incorporated into assessment of individuals’ mobility limitation. Further investigations in the changes in both factors in comparison with other challenging mobility tasks still needed.

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