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Dorothy Farrar- Edwards

Dorothy Farrar- Edwards

Ph.D., Washington University in St. Louis
Professor, Department of Kinesiology-Occupational Therapy
dfedwards@wisc.edu
http://kinesiology.education.wisc.edu/ot/people/graduate-faculty/dorothy-farrar-edwards


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 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
Law, L. L., Schultz, S. A., Boots, E. A., Einerson, J. A., Dougherty, R. J., Oh, J. M., Korcarz, C. E., Edwards, D. F., ... Bendlin, B. B., Carlsson, C. M., Asthana, S., Hermann, B. P., Sager, M. A., Johnson, S. C., ... & Okonkwo, O. C. (2017). Chronotropic response and cognitive function in a cohort at risk for Alzheimer's disease. Journal of Alzheimer's Disease, 56(1), 351-359.
View publication via DOI: DOI:10.3233/jad-160642

Dougherty, R. J., Schultz, S. A., Boots, E. A., Ellingson, L. D., Meyer, J. D., Van Riper, S., Stegner, A. J., Edwards, D. F., ... Bendlin, B. B., Asthana, S., ... Sager, M. A., ... Johnson, S. C., Okonkwo, O. C., & Cook, D. B. (2017). Relationships between cardiorespiratory fitness, hippocampal volume, and episodic memory in a population at risk for Alzheimer's disease. Brain and Behavior. Advance online publication.
View publication via DOI: DOI:10.1002/brb3.625

Gleason, C. E., Dowling, N. M., Benton, S. F., Kaseroff, A., Gunn, W., & Edwards, D. F. (2016). Common sense model factors affecting African Americans' willingness to consult a healthcare provider regarding symptoms of mild cognitive impairment. American Journal of Geriatric Psychiatry, 24(7), 537-546.
View publication via DOI: DOI:10.1016/j.jagp.2015.08.005

Dougherty, R. J., Ellingson, L. D., Schultz, S. A., Boots, E. A., Meyer, J. D., Lindheimer, J. B., ... Edwards, D. F., ... Bendlin, B. B., Asthana, S., ... Sager, M. A., Johnson, S. C., Okonkwo, O. C., & Cook, D. B. (2016). Meeting physical activity recommendations may be protective against temporal lobe atrophy in older adults at risk for Alzheimer's disease. Alzheimer's & Dementia, 4, 14-17.
View publication via DOI: DOI:10.1016/j.dadm.2016.03.005

Remsik, A., Young, B., Vermilyea, R., Kiekhoefer, L., Abrams, J., Evander Elmore, S., Schultz, P., Nair, V., Edwards, D., Williams, J., & Prabhakaran, V. (2016). A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke. Expert Review of Medical Devices, 13(5), 445-454.
View publication via DOI: DOI:10.1080/17434440.2016.1174572

Gleason, C. E., Dowling, N. M., Benton, S. F., Kaseroff, A., Gunn, W., & Edwards, D. F. (2016). Common sense model factors affecting African Americans' willingness to consult a healthcare provider regarding symptoms of mild cognitive impairment. American Journal of Geriatric Psychiatry, 24(7), 537-546.
View publication via DOI: DOI:10.1016/j.jagp.2015.08.005

Young, B. M., Stamm, J. M., Song, J., Remsik, A. B., Nair, V. A., Tyler, M. E., Edwards, D. F., ... Prabhakaran, V. (2016). Brain-computer interface training after stroke affects patterns of brain-behavior relationships in corticospinal motor fibers. Frontiers in Human Neuroscience, 10, 457.
View publication via DOI: DOI:10.3389/fnhum.2016.00457

Morrison, M. T., Edwards, D. F., & Giles, G. G. (2015). Performance Based Testing in Mild Stroke: Identification of Unmet Need for Occupational Therapy. American Journal of Occupational Therapy, 69(1), 6901360010p1 - 6901360010p5.
View publication via DOI: DOI:10.5014/ajot.2015.011528

Schultz, S.A., Boots, E.A., Dougherty, R.J., Almeida, R.P., Oh, J.M., Einerson, K., Korcarz, C.E., Edwards, D., Koscik, R.L., Dowling, N.M., Gallagher, C.L., Bendlin, B.B., Christian, B.T., Zetterberg, H., Blennow, K., Carlsson, C.M., Asthana, S., Hermann (2015). Cardiorespiratory fitness attenuates the influence of amyloid on cognition. Journal of the International Neuropsychological Society, 21(10), 841-850.
View publication via DOI: DOI:10.1017/S1355617715000843

Boots, E.A., Schultz, S.A., Oh, J.M., Larson, J., Edwards, D., Cook, D., Koscik, R.L., Dowling, M.N., Gallagher, C.L., Carlsson, C.M., Rowley, H.A., Bendlin, B.B., ... Johnson, S.C., & Okonkwo, O.C. (2015). Cardiorespiratory fitness is associated with brain structure, cognition, and mood in a middle-aged cohort at risk for Alzheimer's disease. Brain Imaging & Behavior, 9(3), 639-49.
View publication via DOI: DOI:10.1007/s11682-014-9325-9

Song, J., Nair, V. A., Young, B. M., Walton, L. M., Nigogosyan, Z., Remsik, ... Farrar-Edwards, D., ... Prabhakaran, V. (2015). DTI measures track and predict motor function outcomes in stroke rehabilitation utilizing BCI technology. Frontiers in Human Neuroscience, 9, 195.
View publication via DOI: DOI:10.3389/fnhum.2015.00195

Dromerick, A. W., Edwardson, M. A., Edwards, D. F., Giannetti, M. L., Barth, J., Brady, K. P., ... Newport, E. L. (2015). Critical periods after stroke study: Translating animal stroke recovery experiments into a clinical trial. Frontiers in Human Neuroscience, 9, 231.
View publication via DOI: DOI:10.3389/fnhum.2015.00231

Young, B. M., Nigogosyan, Z., Walton, L. M., Remsik, A., Song, J., Nair, V. A., Tyler, M. E., Edwards, D. F., ... Prabhakaran, V (2015). Dose-response relationships using brain-computer interface technology impact stroke rehabilitation. Frontiers in Human Neuroscience, 9, 361.
View publication via DOI: DOI:10.3389/fnhum.2015.00361

Boden-Albala, B., Carman, H., Southwick, L., Parikh, N. S., Roberts, E., Waddy, S., & Edwards, D. (2015). Examining barriers and practices to recruitment and retention in stroke clinical trials. Stroke, 46(8), 2232-2237.
View publication via DOI: DOI:10.1161/strokeaha.114.008564

Okonkwo, O.C., Schultz, S.A., Oh, J.M., Larson, J., Edwards, D., Cook, D., Koscik, R., Gallagher, C.L., Dowling, N.M., Carlsson, C.M., Bendlin, B.B., LaRue, A., Rowley, H.A., Christian, B.T., Asthana, S., Hermann, B.P., Johnson, S.C., & Sager, M.A. (2014). Physical activity attenuates age-related biomarker alterations in preclinical AD. Neurology, 83(19), 1753-1760.
View publication via DOI: DOI:10.1212/WNL.0000000000000964

Boots, E.A., Schultz, S.A., Oh, J.M., Larson, J., Edwards, D., Cook, D., Koscik, R.L., Dowling, M.N., Gallagher, C.L., Carlsson, C.M., Rowley, H.A., Bendlin, B.B., LaRue, A., Asthana, S., Hermann, B.P., Sager, M.A., Johnson, S.C., & Okonkwo, O.C. (2014). Cardiorespiratory fitness is associated with brain structure, cognition, and mood in a middle-aged cohort at risk for Alzheimer's disease. Alzheimer's & Dementia, 10(4), p165.
View publication via DOI: DOI:10.1016/j.jalz.2014.04.163

Boden-Albala, B., Farrar-Edwards, D., St. Claire, S., Wing, J.J., Fernandez, S., Gibbons, M.C., Hsia, A., Dromerick, A.W., & Kidwell, C.S. (2014). Methodology for a Community Based Stroke Preparedness Intervention: The ASPIRE Study. Stroke, 45(7), 2047-52.
View publication via DOI: DOI:10.1161/STROKEAHA.113.003502

Young, B.M., Nigogosyan, Z., Remsik, A., Walton, L.M., Song, J., Nair, V.A., Grogan, S.W., Tyler, M.E., Edwards, D.F., Caldera, K., Sattin, J.A., Williams, J.C., & Prabhakaran, V. (2014). Changes in Functional Connectivity Correlate with Behavioral Gains in Stroke Patients after Therapy Using a Brain-Computer Interface Device. Frontiers in Neuroengineering, 8(7), 25.
View publication via DOI: DOI:10.3389/fneng.2014.00025

Song, J., Young, B. M., Nigogosyan, Z., Walton, L. M., Nair, V. A., Grogan, S. W., Tyler, M. E., Farrar-Edwards, D., ... Prabhakaran, V. (2014). Characterizing relationships of DTI, fMRI, and motor recovery in stroke rehabilitation utilizing brain-computer interface technology. Frontiers in Neuroengineering, 7, 31.
View publication via DOI: DOI:10.3389/fneng.2014.00031

Morrison, M. T., Giles, G. M., Ryan, J. D., Baum, C. M., Dromerick, A. W., Polatajko, H. J., & Edwards, D. F. (2013). Multiple errands test-revised (MET-R): A performance-based measure of executive function in people with mild cerebrovascular accident. American Journal of Occupational Therapy, 67(4), 460-468.
View publication via DOI: DOI:10.5014/AJOT.2013.007880

Ovbiagele, B., Wing, J. J., Menon, R. S., Burgess, R. E., Gibbons, M. C., Sobotka, I., . . . Edwards, D. F., & Kidwell, C. S. (2013). Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage. Stroke, 44(9), 2409-2413.
View publication via DOI: DOI:10.1161/strokeaha.113.001958

Edwards, D. F., Menon, R., Fokar, A., Gibbons, C., Wing, J., Sanchez, B., & Kidwell, C. S. (2013). Recruitment of black subjects for a natural history study of intracerebral hemorrhage. Journal of Health Care for the Poor and Underserved, 24(1), 27-35.
View publication via DOI: DOI:10.1353/HPU.2013.0007

Thraen-Borowski, K. M., Trentham-Dietz, A., Edwards, D. F., Koltyn, K. F., & Colbert, L. H. (2013). Dose-response relationships between physical activity, social participation, and health-related quality of life in colorectal cancer survivors. Journal of Cancer Survivorship, 7(3), 369-378.
View publication via DOI: DOI:10.1007/s11764-013-0277-7

Tucker, F. M., Edwards, D. F., Mathews, L. K., Baum, C. M., & Connor, L. T. (2012). Modifying health outcome measures for people with aphasia. The American Journal of Occupational Therapy, 66(1), 42-50.
View publication via DOI: DOI:10.5014/ajot.2012.001255

Berg, C., Edwards, D. F., & King, A. (2012). Executive function performance on the children's kitchen task assessment with children with sickle cell disease and matched controls. Child Neuropsychology, 18(5), 432-448.
View publication via DOI: DOI:10.1080/09297049.2011.613813

Edwards, D. F., Lang, C. E., Wagener, J. M., Birkememier, R., & Dromerick, A. W. (2012). Choosing a Measure for Arm Motor Trials and Clinical Care Early after Stroke: An Evaluation of the Wolf Motor Function Test. Archives of Physical Medicine and Rehabilitation, 93, 660-668.
View publication via DOI: DOI:10.1016/j.apmr.2012.05.002

Zahuranec, D. B., Wing, J. J., Edwards, D. F., Menon, R. S., Fernandez, S. J., Burgess, R. E., . . . Kidwell, C. S. (2012). Poor long-term blood pressure control after intracerebral hemorrhage. Stroke, 43(10), 2580-2585.
View publication via DOI: DOI:10.1161/strokeaha.112.663047

Chang, Y. P., Edwards, D. F., & Lach, H. W. (2011). The collateral source version of the geriatric depression scale: Evaluation of psychometric properties and discrepancy between collateral sources and patients with dementia in reporting depression. Psychogeriatrics, 23(6), 961-968.
View publication via DOI: DOI:10.1017/s1041610211000147

Hsia, A. W., Castle, A., Wing, J. J., Edwards, D. F., Brown, N. C., Higgins, T. M., . . . Kidwell, C. S. (2011). Understanding reasons for delay in seeking acute stroke care in an underserved urban population. Stroke, 42(6), 1697-1701.
View publication via DOI: DOI:10.1161/strokeaha.110.604736

Hsia, A. W., Edwards, D. F., Morgenstern, L. B., Wing, J. J., Brown, N. C., Coles, R., . . . Kidwell, C. S. (2011). Racial disparities in tissue plasminogen activator treatment rate for stroke: A population-based study. Stroke, 42(8), 2217-2221.
View publication via DOI: DOI:10.1161/strokeaha.111.613828

Foster, E. R., Cunnane, K. B., Edwards, D. F., Morrison, M. T., Ewald, G. A., Geltman, E. M., & Zazulia, (2011). Executive dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart failure. American Journal of Occupational Therapy, 65(3), 306-313.
View publication via DOI: DOI:10.5014/ajot.2011.000588

Dromerick, A. W., Gibbons, M. C., Edwards, D. F., Farr, D. E., Giannetti, M. L., Sanchez, B., . . . Kidwell, C. S. (2011). Preventing recurrence of thromboembolic events through coordinated treatment in the District of Columbia. International Journal of Stroke, 6(5), 454-460.
View publication via DOI: DOI:10.1111/j.1747-4949.2011.00654.x

Lach H., Chang Y., & Edwards, D. F. (2010). Can Older Adults with Dementia Accurately Report Depression Using Brief Forms? Reliability and Validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5) 30-37.
View publication via DOI: DOI:10.3928/00989134-20100303-01

Williams, M. M., Scharff, D. P., Mathews, K. J., Hoffsuemmer, J. S., Jackson, P., Morris, J. C., & Edwards, D. F. (2010). Barriers and facilitators of African American participation in Alzheimer disease biomarker research. Alzheimer Disease and Associated Disorders, 24 Suppl, S24-29.
View publication via DOI: DOI:10.1097/WAD.0b013e3181f14a14

Scharff, D. M., Williams, M. M., Mathews, K. J., Hofshumer, J. P., & Edwards, D. F. (2010). More than Tuskegee: Understanding mistrust about research participation. Journal of Healthcare for the Poor and Underserved, 21(3), 879-897.
View publication via DOI: DOI:10.1353/hpu.0.0323

Dromerick, A. W., Lang, C. E., Birkenmeier, R. L., Wagner, J. M., Miller, J. P., Videen, T. O., . . . Edwards, D. F. (2009). Very early constraint-induced movement during stroke rehabilitation (VECTORS): A single-center RCT. Neurology, 73(3), 195-201.
View publication via DOI: DOI:10.1212/WNL.0b013e3181ab2b27

Dromerick, A.W., Edwards, D.F., & Kumar, A. (2008). Hemiplegic shoulder pain syndrome: Frequency and characteristics during inpatient stroke rehabilitation. Archives of Physical Medicine & Rehabilitation, 89(8), 1589-9.

Lang, C.E., Edwards, D.F., Birkenmeier, R.L., & Dromerick, A.W. (2008). Estimating minimal clinically important differences of upper-extremity measures early after stroke. Archives of Physical Medicine & Rehabilitation, 89(9), 1693-70.

Edwards, D.F., & Morris, J.C. (2007). Alone and confused: Community-residing older African Americans with dementia. Dementia, 6(4), 489-506.

Carpenter, B.D., Edwards, D.F., Pickard, J.G., Palmer, J.L., Morrow-Howell, N., Neufeld, P.S., Perkinson, M.A., Stark, S., Morris, J.C. (2007). Anticipating relocation: Concerns about moving among NORC residents. Journal of Gerontological Social Work, 49(1-2), 165-84.

Wilkins, C.H., Wilkins, K.L., Meisel, M., Depke, M., Williams, J., & Edwards, D.F. (2007). Dementia undiagnosed in poor older adults with functional impairment. J. Am. Geriatr. Soc., 55(11), 1771-6.

Edwards, D.F., Hahn M.G., Sheedy C., Hsu C., & Dromerick, A.W. (2006). Post stroke incontinence and quality of life: When does urinary loss become incontinence? Neurourology and Urodynamics, 25(1), 39-45.

Edwards, D.F., Hahn, M.G., Baum, C., Perlmutter, M.S., Sheedy, C., & Dromerick, A.W. (2006). Undetected impairment in persons with stroke: Validation of the post-stroke rehabilitation guidelines. Neurorehabilitation and Neural Repair, 20, 42-48.

Edwards, D.F., Hahn, M.G., Baum, C.M., & Dromerick, A.W. (2006). The impact of mild stroke on activity participation and life satisfaction. Journal of Stroke and Cerebrovascular Disease, 15, 151-157.

Dromerick, A.W., Lang, C.E., Birkenmeier, R., Hahn, M.G., Sahrmann, S.A., & Edwards, D.F. (2006). Relationships between arm functional limitation and disability in persons enrolled in the VECTORS trial: Examining a population of stroke patients with hemiparesis. Journal of Rehabilitation Research and Development, 43, 401-408.

Stark, S., Edwards, D.F., Hollingsworth, H., & Gray, D. (2005). Validation of the Reintegration to Normal Living index on a population of community dwelling people with mobility limitation. Archives of Physical Medicine and Rehabilitation, 86(2), 344-5.

Li, H., Edwards, D.F., & Morrow-Howell, N. (2004). Utilization of formal and informal support by caregivers of African American elders with dementia. Family Relations, 85(1), 55-63.

Baum, C.M., & Edwards, D. (2003). What persons with dementia can do: A tool for communication about daily activities. Alzheimer's Care Quarterly, 4, 108-118.

Dromerick, A.W., Edwards, D.F., & Hahn, M.G. (2000). Does the application of constraint induced movement therapy during acute rehabilitation reduce hemiparesis after stroke? Stroke, 31, 2984-2988.

Baum, C.M., Edwards, D.F., & Perlmutter, M. (2000). Measuring function in Alzheimer's disease. Alzheimer's Care Quarterly, 1, 44-61.

Baum, C.M., & Edwards, D.F. (2000). Documenting productive behaviors: Using the Functional Behavior Profile to plan discharge following stroke. Journal of Gerontological Nursing, 26, 34-43.

Edwards, D.F., Baum, C.M., Meisel, M., Depke, M., Williams, J., Braford, T., Morrow-Howell, N., & Morris, J.C. (1999). Home-based multidisciplinary diagnosis and treatment of inner city elderly with dementia. The Gerontologist, 39, 483-488.

Baum, M.C., McGeary, T., Pankiewicz, R., Braford, T., & Edwards, D.F. (1996). An activity program for cognitively impaired low-income inner city residents. Topics in Geriatric Rehabilitation, 12(2), 54-62.

Edwards, D.F., & Baum, M.C. (1996). Functional performance of inner city African-American older persons with dementia. Topics in Geriatric Rehabilitation, 12(2), 17-27.

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