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Research

Dorothy F. Farrar

Ph.D., Washington University in St. Louis
Associate Professor, Department of Kinesiology-Occupational Therapy
dfedwards@education.wisc.edu

Understanding Cognitive Determinants of Independence in Complex Life Activities, Activity Participation and Quality of Life

My multidisciplinary research addresses the effects of aging on functional independence and quality of life. The central goal of my research is to contribute to the understanding of quality of life and well-being in older adults by examining the impact of cognitive and physical impairment on performance of complex activities of everyday life. My research explores questions of functional performance, caregiver burden, and treatment outcomes in a variety of populations ranging from normal aging to neurological diseases such as Alzheimer�s disease and stroke. I am particularly interested in the aging process in African Americans. The ultimate aim of these studies is to support the development and implementation of more effective interventions for persons with cognitive loss and their families.

Effects of Neurological Impairment
My studies have explored the impact of neurological impairments such as Alzheimer's disease and stroke on occupational performance. Occupational performance can be defined as the dynamic experience of a person engaged in purposeful activities within an environment. I focus on the factors that support engagement in community activities and quality of life for the individual and his /her family. From a rehabilitation science perspective, disability is the end product of the interaction between health conditions, personal factors, and the environment. Participation in everyday life is the ultimate outcome of rehabilitation interventions. This approach emphasizes the value of the individual�s subjective assessment of the impact of a medical condition, illness or injury on participation in life activities, roles and emotional wellbeing. I integrate both disability and the health related outcomes perspectives in my studies. I am particularly interested in the dynamic interaction among these factors in persons with Alzheimer�s and stroke.

Stroke Outcome
I am currently conducting a longitudinal study of persons with very mild stroke. An aim of this study is to characterize both deficits and preserved function in learning and memory after very mild stroke using cognitive and neurobiologically motivated tasks. An additional goal is to determine whether patients fall into dissociable subtypes using behavioral and structural neuroimaging measures, and if so, to determine whether sub-typing predicts functional outcome. Preliminary data suggests that despite minimal residual neurological deficits, approximately 40 % of these individuals have subtle but significant deficits in executive function. These deficits appear to inhibit return to pre-stroke levels of activity participation particularly in areas such as work and productive activities. This study is also designed to dissociate the effects of depression and executive function deficits in a very carefully selected sample.

Stroke Rehabilitation Studies
I have been a co-investigator with my colleague Alexander Dromerick MD on two randomized controlled trials of Constraint-Induced Movement Therapy (CIMT) for upper extremity hemiparesis in the acute stages of stroke recovery. Constraint Induced Movement Therapy is a learning based treatment designed to capitalize on neural plasticity in the early stage of stroke recovery. Our first study demonstrated that CIM could be safely and effectively implemented within 14 days of stroke onset. We have just completed a second study to further develop the methodology for a multicenter RCT of early intervention for upper extremity hemiparesis. As part of this study, we compared the effectiveness of CIMT to a standardized treatment of equal intensity and duration. We have also examined the reliability, validity and responsiveness of upper extremity assessments as well as the relationship of the clinical assessments to kinematic measures of quality of movement and functional outcomes.

Studies of Alzheimer's Disease in Minority Elders
The Memory and Aging satellite of provides home based diagnosis, treatment, and case management for minority and medically under served residents of the St. Louis metropolitan area. This program has both research and clinical functions. We have examined the role of the environment and habits of every day life in supporting the preservation of functional independence in persons with cognitive loss. As part of this research we studied a large group of African American elders who live alone despite their dementia. The factors associated with formal and informal service in this population have been documented. We have also explored the relationship between family caregiving networks and unmet need in the patients, as well as predictors of the failure of primary care physicians to diagnose AD.

Through this project, I became interested in identification of barriers to research participation in African Americans. We recently completed a series of key informant interviews and focus groups designed to explore reactions participation in research using more invasive diagnostic procedures such as lumbar punctures and neuroimaging, as well as willingness to participate in clinical treatment trials. We also assessed attitudes of African American physicians towards referring patients to clinical studies and randomized controlled trials. Our data suggests that in making decisions about participation in clinical studies, elderly African Americans look to their physicians and their adult children for guidance and approval. Negative attitudes or concerns voiced by these �gatekeepers� are a significant factor in the decision to proceed with a study. I hope to further explore the attitudes of these two groups and work to develop educational programs and recruitment materials specifically designed to address their concerns.

Representative Publications

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