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Rehabilitation Sciences Institute

Marla BeauchampStudent Name: Marla Beauchamp
Program: Graduate Department of Rehabilitation Sciences
PhD Thesis Title:  Balance Assessment and Treatment in Individuals with Chronic Obstructive Pulmonary Disease

Thesis Abstract
Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with chronic obstructive pulmonary disease (COPD). The main objective of this thesis was to describe balance impairment and fall risk in individuals with COPD and to examine interventions for improving balance and reducing fall risk in the context of pulmonary rehabilitation. The first study of this thesis showed that falls are common in patients with COPD and that fallers are characterized by impairments in standard clinical balance measures, such as the Berg Balance Scale and Timed Up and Go. In the second study, we found that the exercise component of conventional pulmonary rehabilitation has only modest effects on balance and fall risk in COPD, highlighting the need to examine the role of balance-specific training for these patients. The third study of this thesis identified the postural control subsystems most responsible for the observed balance deficits in COPD. Compared with age-matched controls, individuals with COPD demonstrated reductions in all balance control subsystems and slower reaction times in response to external perturbations. In this study, we also showed that deficits in balance in patients with COPD were associated with peripheral muscle weakness and reduced physical activity levels. These results informed the design of the final study of this thesis, a randomized controlled trial evaluating the addition of specific balance training to pulmonary rehabilitation for improving balance in patients with COPD. Preliminary results from this study suggest that the addition of thrice weekly balance exercises to a conventional pulmonary rehabilitation program is effective for optimizing gains in measures of functional balance and fall risk. The findings from the four studies included in this thesis support the need for incorporating balance assessment and treatment for at-risk patients with COPD, as part of their comprehensive management.

Scholarships

  • Canadian Institutes of Health Research Fellowship, $55,000 per year (2012-2015)
  • Canadian Institutes of Health Research Fellowship, $50,000 per year (2009-2012)
  • Canadian Respiratory Health Professionals Fellowship, $7,500 (2009-2010)
  • Ontario Respiratory Care Society Fellowship, $8,000 (2009-2010)
  • Canadian Respiratory Health Professionals Fellowship, $7,500 (2008-2009)
  • Ontario Respiratory Care Society Fellowship, $7,500 (2008-2009)
  • University of Toronto, Faculty of Medicine, Peterborough  K.M. Hunter Adams Graduate Studentship, $10,000 (2008-2009)
  • Ontario Graduate Scholarship, $15,000 (2008-2009)- declined
  • Canadian Respiratory Health Professionals Fellowship, $7,500 (2007-2008)
  • Ontario Respiratory Care Society Fellowship, $7,500 (2007-2008)
  • University of Toronto, Faculty of Medicine, Peterborough  K.M. Hunter Adams Graduate Studentship, $20,000 (2007-2008)

Awards

  • European Respiratory Society Travel Award for best poster in COPD, European Respiratory Society Congress, Amsterdam, Netherlands, September 24-28, 2011.
  • Department of Physical Therapy, University of Toronto, Teaching Recognition Award (2011)
  • Knowledge Translation Award, Canadian Respiratory Health Professionals (2010)
  • Department of Physical Therapy, University of Toronto, Teaching Recognition Award (2010)
  • Travel Award from the CIHR Institute of Circulatory and Respiratory Health for the Canadian Student Health Research Forum, June 3, 2009, Winnipeg.
  • Lisa Cicutto Award for Best Poster by a student investigator, Better Breathing Conference (2009)
  • Department of Physical Therapy, University of Toronto, Teaching Recognition Award (2009)
  • Ruth Bradshaw Award for academic excellence  (2008)
  • Heart and Breadth of Physical Therapy Award for clinical excellence in cardiorespiratory physiotherapy  (2007)
  • University Health Network Book Prize for clinical and academic excellence in neuroscience (2007)

List of Publications

  1. Beauchamp MK, Evans R, Janaudis-Ferreira T, Goldstein RS, Brooks D. A systematic review and meta-analysis of post-rehabilitation maintenance exercise programs in individuals with COPD. Submitted.
  2. Canestraro A, Nakhle A, Stack M, Strong K, Wright A, Beauchamp MK, Berg K, Brooks D. Oncology rehabilitation provision and practice patterns across Canada. Physiotherapy Canada. In press.
  3. Beauchamp MK, Sibley K, Lakhani B, Romano J, Mathur S, Goldstein RS, Brooks D.  Impairments in systems underlying control of balance in chronic obstructive pulmonary disease. Chest 2012;141:1496-503.
  4. Beauchamp MK, Harvey RH, Beauchamp P. Biofeedback and psychological skills training for performance enhancement: an applied three-year integrated program for Canada’s Olympic Short Track Speedskating Team. Journal of Clinical Sports Psychology 2012;6:67-84.
  5. Beauchamp MK. Clinician’s Commentary. Physiotherapy Canada 2011;63(4):432-33.
  6. Janaudis-Ferreira T, Beauchamp MK, Goldstein RS, Brooks D. How should we measure arm exercise capacity in COPD? A systematic review. Chest Published Online First: June 9, 2011, doi:10.1378/chest.11-0475
  7. Beauchamp MK, Janaudis-Ferreira T, Goldstein RS, Brooks D. Optimal duration of pulmonary rehabilitation for individuals with COPD- a systematic review. Chronic Respiratory Disease 2011;8(2):129-40.
  8. Harvey R, Beauchamp MK, Saab M, Beauchamp P. Biofeedback reaction-time training: toward Olympic gold. Biofeedback 2011;39(1):7-14. 
  9. Beauchamp MK, Brooks D, Goldstein RS. Deficits in postural control in individuals with COPD- emerging evidence for an important secondary impairment. Multidisciplinary Respiratory Medicine 2010;5(6):417-21.
  10. Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Wadell K, Brooks D. Resistance arm training in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Chest 2011;139(1):151-8.
  11. Beauchamp MK, O’Hoski S, Goldstein RS, Brooks D. The effect of pulmonary rehabilitation on balance in individuals with COPD. Archives of Physical Medicine and Rehabilitation 2010;91(9):1460-5.
  12. Beauchamp MK, Nonoyoma M, Goldstein RS, Hill K, Dolmage T, Mathur S, Brooks D. Continuous versus interval exercise training in COPD- a systematic review. Thorax 2010;65:157-64.
  13. Beauchamp MK, Hill K, Goldstein RS, Janaudis-Ferreira T, Brooks D. Impairments in balance discriminate fallers from non-fallers in COPD. Respiratory Medicine 2009;103(12):1885-91.
  14. Beauchamp MK, Skrela M, Southmayd D, Trick J, Van Kessel M, Inness E, Brunton K, McIlroy WE. Immediate effects of cane use on gait symmetry in individuals with sub-acute stroke. Physiotherapy Canada 2009;61(3):154-160.
  15. Beauchamp M, Grey V, Lands LC. Sweat collection for testing in Canadian Cystic Fibrosis Centers, is it optimal? Clinical Biochemistry 2005;38(10):934-937.
  16. Beauchamp M, Lands LC. Sweat-testing: a review of current technical requirements. Pediatric Pulmonology 2005;39:507-511.

Present Position
Postdoctoral Research Fellow
Department of Physical Medicine and Rehabilitation
Harvard University
Spaulding Cambridge Outpatient Hospital
Cambridge, MA