Final Thomas

7/28/2019 Final Thomas

1/19

+

Single Subject Design CritiqueArticle:Running Training After Stroke: A Single-Subject Report

Marie Wolf-Hatalowich, Anita Powell, Jamie Moore, Linda Mason


2/19

+Type of Single System Design

Explanatory Design

A-B single subject design

Purpose Use of intensive task oriented, training in body-

weight-support treadmill (BWST) environment

Intervention

Improve running for a subject after a stroke Does BWST running cause change in the dependent

variable?

Maintain improvements


3/19

+Type of Single System Design

Subject

38 year old male

Medical History Stroke (CVA) 2.5 years prior to study

Effects

Right embolic stroke

Results in left side hemiparesis


4/19

+Strengths & Weaknesses of Design

Degree to which results are attributable to independentvariable and not some other rival explanation

Threats to internal validityHistory Ex: Illness

Maturation Ex: Becoming tired due to tedious task

Instrumentation error Participants can become more skilled or bored

Respond more differently to running in morning than inevening

Internal Validity


5/19


Testing

Ex: Pretest alerts participant about experiment

Statistical error Ex: Disadvantaged subjects

Differential selection of evaluation of participants

Ex: Participants know they are being tested react to demands

Mortality Ex: Participants may drop out of study

Reactive effects

Ex: Participants talk about an ongoing experiment

Threats to internal validity


6/19


Experiment results apply to different populations &

situations that are different from your experiment

Threats to External Validity Pretesttreatment interaction Response/reaction to treatment because of pretest

Specificity of variables

Specific group at specific time in specific setting

Reactive effects

Participants tend to do what can do not what they want to do

Multiple treatment interference

Results of 1st intervention affect the results of 2nd intervention

Researcher Bias

Researchers tend to see what they want to see

External Validity


7/19

+Description of Measurement Plan

Baseline During Intv Immediate 6 months

Number

of times

tested

10 1 9 9

Length of

time

3 weeks 8 weeks 3 weeks 3 weeks

1. Trained Specialist

2. Competency

3. Familiarization period


8/19


Independent Variable Body Weight Support

Dependent Variables

Activity Limitations

1. 25m sprint

2. Single-leg balance

3. Stride length

4. Stride width

ParticipationRestriction

1. SIS

physical

emotional

handicap

stroke recovery

Body Functions

1. LE strength

2. 6 minute walk


9/19


Type R/N How Why Rely Valid

Ratio Reactive Sec/m Running

speed

Yes Yes

Ratio Reactive Seconds PredicatorOf speed

Yes Not for

stroke

Ratio Reactive Mid 3

avg

Increase

Speed

Yes Yes

Ratio Reactive Mid 3

avg

Symmetry Yes Yes


10/19


Type R/N How Why Rely Valid

Ratio Reactive DynamometerExperienced

Clinician

Leg

Strength

.96 -.98 .94 -.97

Ratio Reactive Meters Cardio .99 Yes

Interval Reactive Interview

Scale

Quality

of Life

.57-.92 .44 -.84


11/19

+Critique of Measurement Plan

History

Testing

Reactive Effects

Threats to Internal Validity


12/19

+Informed Consent

Release of information from

physician obtained

Medical history: unremarkable

Informed consent obtained (IRB)

Limited information regardingconsent ingredients


13/19

+Ethical Issues Related to Study

During the intervention, participant was

informed he could terminate at any time

Self-report other variables to considerrelated to results

Stroke can cause range of cognitive

impairments


14/19

+Suggested Changes

A-B is most appropriate

For example, A-B-A (cant reverse

this intervention-unethical)

Assessment of cognitive

functioning prior to

Comparison of TBI and stroke

survivors


15/19

+Implications for Social Work

Causal relationships (intervention caused result)

+ Systematic monitoring

+ Recorded results

= Evidenced Based literature

Starts with a clearly defined problem

Post stroke victim wants to regain ability to run

Hypothesis

If intervention is done, it will improve ability to run & QOL


16/19


Establish baseline

10 repeat measurements over 3 weeks

Introduce intervention

AB design with retention phase for ethical reasons

Carryover effects

Clients well-being top priority

Study performed over time

Initial phase + 2 retention phases

Record and analyze data

Physical data + qualitative data


17/19


Most important outcome: QOL benefit

Progress attributable to pre-stroke condition

Crisis theory model: person reverts to pre-trauma

functioning level

Process provided opportunity

Participant reports he learned how to do it

Repeat studies indicated

Added to professional knowledge base

Better step length ratio unnecessary to gain benefitsLearning adaptive patterns yielded maintained benefits


18/19

+Relevance to Rural Social Work

Gold standard results that can be generalized

Dataneedsadaptedforruralapplication

SSD Lends itself to rural conditions

Results are highly personalized

Ideal because data is collected from the individualthe study is intended to help

SSD can be performed with limited resourcesWhat rural areas lack in mass and specialized

personnel they compensate for with social capitol Value of combined resources of networks of trust,

reciprocity, information, and cooperation


19/19

+Relevance to Rural Social Work

SSD builds upon critical rural value of trust

Adds to Ability to collect qualitative data

Trust in rural communities is ideal for gatheringpersonal, qualitative data

Qualitative data gives insight to QOL benefits

Qualitative data revealed contributing factors wereparticipants motivation and positive attitude

Most important outcome was QOL gained from

being able to run with wife again

Trust

Documents

Final Thomas