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Title: Effect of urban walking environment on upper body control and illness behaviour in patients with balance problems
Author: Omar, Marniza
ISNI:       0000 0004 5921 2198
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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This thesis attempts to investigate the effect of an urban walking environment on postural control, using tri-axial accelerometers, while walking in healthy individuals and individuals with vestibular disorders or stroke. This thesis also investigates illness behaviour, using illness behaviour questionnaire (IBQ) in individuals with vestibular disorder or vestibular migraine. The first two studies (Chapter 2 and Chapter 3) of the current thesis explored the effectiveness of use of accelerometers in measuring upper body stability control when walking in real urban environment for healthy individuals and individuals with a vestibular disorder or stroke. The findings of the current study showed that accelerometers can be used to measure gait and balance impairment particularly in outdoor settings i.e. urban walking environment. The findings demonstrated that accelerometers were able to differentiate the postural strategies utilised by people with a vestibular disorder or stroke compared to healthy controls. More specifically, both patient groups employed compensatory mechanisms including reduced walking speed and reduced trunk accelerations in order to maintain postural stability during gait in urban environments. However, greater AP head accelerations were noted in patients with stroke, indicating that stroke patients have difficulties stabilizing their head in space during walk in urban environment. In addition, mobilising on uneven surfaces had greatest effect and induced head instability particularly in ML direction in patients with vestibular disorders and in the AP direction (the direction of progression) in patients with stroke. These results indicate that walking in an urban environment provides challenges to postural stability control in people with vestibular disorders or stroke. The final study (Chapter 4) of the thesis investigated the pattern of illness behaviour by using illness behaviour questionnaire (IBQ) in patients with vestibular impairment including vestibular migraine. Findings of this study showed that the IBQ can be used to differentiate illness behaviour patterns between patients with vestibular disorders including vestibular migraine and healthy controls. Patients with vestibular migraine show a significantly greater fear concern about their health status, disease conviction, dysphoria and irritability which suggested the global aspects of abnormal illness behaviour. In addition greater anxiety and depression level were also noted in people with migraine. Overall, the three studies in the current thesis present novel findings and open up to further exciting areas of research aiming at intervention options for patients with vestibular disorders, vestibular migraine or stroke. Investigation of patient's functional mobility in real environment and the examination of patient's illness behaviour associated with their vestibular impairment may provide a critical way to identify and better understand factors that could hinder some individuals from responding well to their interventions.
Supervisor: Pavlou, Marousa Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available