Philippa J. Clarke

Outdoor Environmental Facilitators and Barriers of Stroke Survivors: Mobility and Functional Status

Research Project Description
Natalie Colabianchi, Erica Elizabeth Twardzik, Lynda Diane Lisabeth, Philippa J. Clarke, Susan H. Brown, Lewis B. Morgenstern, Neil Burton Alexander

Stroke is a leading cause of serious long-term disability within the United States, and it affects an estimated 6.6 million Americans over age 20. Medical advances in treatment of acute stroke and an aging population has resulted in greater prevalence of stroke in our population, and many stroke patients return directly home. With a greater number of stroke survivors living in their local community, it is critical to determine which features of the local environment best support stroke survivors, especially features that support mobility. Mobility impacts health through various mechanisms, including access to food and health services, mitigation of chronic health disease development, and involvement in civic life. The overarching objective of this research project is to determine which features of the environment are most important for stroke survivors living in their home community. Within this research project, we propose the following aims: 1) identify which environmental features (e.g. sidewalk width, unequal surfaces) require the most mobility adaptation (e.g. increasing stride length, slowing gait speed) in real time using wearable sensors within a population of stroke survivors; 2) examine the association between environmental features found on participants? residential block and the 3-year trajectory of quality of life post stroke; and 3) examine the association between participants? residential proximity to community amenities (e.g. library, senior center) and the 3-year trajectory of quality of life post stroke. The theoretical framework that guides our empirical analysis is the International Classification of Functioning, Disability and Health. This framework suggests that a disability is the result of complex interaction between environmental context and individual function. Contextual factors are defined as the environments in which people live, including the built environment and the social environment. In Aim 1, participants will be asked to traverse a pre-defined outdoor course, where we will document real-time mobility using wearable technology. The information gathered will inform our secondary data analysis in Aims 2 and 3, where we will examine environmental features within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. The proposed work will identify environmental features that shape stroke survivors? function and participation. This research can then be used to inform policy and practice, with an ultimate goal of enhancing independent mobility for stroke survivors and others with mobility limitations.

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Funding Period: 5/1/2019 to 4/30/2021

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