Medicine and Health Sciences Commons^™

A Novel Approach Toward Concussion Testing, Jorge K. Mercado, Ari Schacter, Danielle Euzent

Student Theses

A concussion is a violent jarring or shaking of the head caused by whiplash or direct impact that results in a disturbance of brain function. Concussions can be mild and brief, as a person may be dazed momentarily or can be more serious, resulting in a loss of consciousness. Underreporting of concussions is prevalent because they are a symptom-based diagnosis, lacking a clinical test. In this study, we investigated the use of VNG testing as a clinical diagnosis of concussions. Looking at the VNG test battery, the previous research cohort found that saccades, gaze, and positional testing are the most …

Investigating The Effects Of Trans-Spinal Direct Current Stimulation On The Expression Of Nkcc1 In Mice, Pasindu Weliwaththage

Student Theses

Trans-spinal direct current stimulation (tsDCS) is a non-invasive powerful tool demonstrated to positively affect behavior and motor function. tsDCS is a neuromodulatory technique capable of altering spinal and cortical excitability and even regain motor function after complete motor paralysis (Cortes et at, 2017). tsDCS causes immediate and long-term effects in spinal excitability (Ahmed, 2011, 2013; Ahmed and Wieraszko, 2012; Cogiamanian et al., 2011, 2012). Studies have been conducted on both healthy and injured subjects. The ultimate goal is to ameliorate the devastating effects of Spinal Cord Injury. Though researchers have been successful in improving motor function, the molecular basis of …

The Effect Of A Single Bout Of Physical Exertion On Expressive Language And Word Finding In Individuals With Multiple Sclerosis, Marissa A. Barrera

Dissertations, Theses, and Capstone Projects

To date, little research has been conducted on the relationship between fatigue and expressive language among Multiple Sclerosis patients (MS). This study was a response to this knowledge gap. A nonrandom, matched- subject, mixed-factor design model was used with a purposive sample of 17 individuals with MS (five had primary-progressive (PP) MS, and 12 had relapsing-remitting (RR) MS). The research design was subjected to pretesting to ensure validity. Participants were assessed on a range of language tasks after undergoing one bout of cardiovascular exercise (NuStep T5 Recumbent Cross Trainer) and asked to provide a subjective fatigue score. The expressive language …

The Efficacy Of Motor Imagery Training On Range Of Motion, Pain And Function Of Patients After Total Knee Replacement, Noorelhoda Mahmoud, Marc A. Razzano Jr., Karen Tischler

Dissertations, Theses, and Capstone Projects

The present study examined the potential of motor imagery training and investigated the role of motor imagery instructions (audio) to improve knee range of motion after a total knee replacement. The participants were randomly assigned to either an experimental motor imagery group (n=4) or a control group (n=6). Both groups performed specific exercises to improve their knee range of motion and strengthen their muscles. Participants in the Motor Imagery group performed a motor imagery training exercise for a knee flexion stretch on the stairs prior to performing the actual exercise. The motor imagery group demonstrated a significantly greater increase in …

Reliability Of Clinical Evaluators Of Spasticity In Patients With Stroke, Tiffany Alvino, Shiney David, Chelsea Gendvil

Dissertations, Theses, and Capstone Projects

Spasticity is characterized by hyperexcitable stretch reflexes with amplitude increases in response to velocity dependent passive movement and resistance. Spasticity is the result of abnormal function of segmental and suprasegmental neuronal circuits. The objective of this study was to determine any positive correlation between three clinical evaluators of spasticity (i.e., the pendulum test, the patellar tendon tap test (PTT), and the Modified Ashworth scale) in their reliability to assess spasticity in people post-stroke. It was hypothesized that the use of force movement sensors along with surface electromyography increases the reliability of the standardized clinical tests. The results show that all …

Multi-Digit Coordination In Absence Of Cutaneous Sensory Feedback During Grasping Tasks, Christina Gioeli, Kerry Mcpartlan, Emily Reid, Matthew Turturro

Dissertations, Theses, and Capstone Projects

Motor learning and adaptation to object properties and task requirements requires integration of cutaneous sensory feedback with motor commands. Joint mechanics constantly change, with individual joints or muscles compensation so performance output is the same per task. Effects of mixed cutaneous sensory feedback on multi-digit coordination is not well understood. Investigators sought to determine the influence absent cutaneous sensory feedback has on motor learning and adaptation, and how the CNS coordinates multi-digit mechanical output to adapt to manual tasks, with partially intact digital sensory feedback. 19 participants were randomly assigned for three-digit anesthesia administration (TIM- thumb, index, middle; TRL- thumb, …

Paired Associative Transspinal And Transcortical Stimulation Produces Bidirectional Plasticity Of Human Cortical And Spinal Motor Pathways, Luke Dixon, Mohamed Ibrahim, Danielle Santora

Dissertations, Theses, and Capstone Projects

Anatomical, physiological, and functional connectivity exists between primary motor cortex (M1) and spinal cord neurons. Paired associative stimulation (PAS) produces enduring changes in M1 based on the Hebbian principle of associative plasticity. The present study aims to discover immediate neurophysiological changes on human corticomotor pathways by pairing noninvasive transspinal and transcortical stimulation via transcranial magnetic stimulation (TMS). We delivered paired transspinal and transcortical stimulation for 40-min at precise interstimulus intervals with TMS being delivered after (transspinal-transcortical PAS) or before (transcortical-transspinal PAS) transspinal stimulation. Transspinal-transcortical PAS markedly decreased intracortical inhibition, increased intracortical facilitation and M1 excitability with concomitant decreases of motor …

Physiopathology And Intervention In Osteoarthritis: A Systematic Review, Justin Gelesky, Dylann C. Germann, Amanda Percaccio, Rachelle Schick

Dissertations, Theses, and Capstone Projects

In the United States, osteoarthritis (OA) is the most common chronic illness in the adult population affecting an estimated 27 million individuals with a yearly health care cost of over $150 billion (CDC, 2014; Lawrence et al., 2008). The pathological osteoarthritic process results in the progressive degradation of articular cartilage due to chemical and biological imbalances within a joint (Weiland et al., 2005). These imbalances are not well understood and neither are the biomechanical joint changes that occur as a result. Due to these limitations, treating and monitoring this condition is a challenge to clinicians and the processes are currently …

Developmental Coordination Disorder: The Relationship Between Gait And Attention With Possible Implications For Early Identification And Intervention, Yocheved Bensinger-Brody

Dissertations, Theses, and Capstone Projects

The aim of this research was to evaluate how increased levels of challenge to attentional capacity would affect the motor planning and coordination in the gait of children at risk of Developmental Coordination Disorder (DCD) across developmental ages. The study incorporated a dual task paradigm requiring both motor and attention performance, with the primary hypothesis that children who are at risk of DCD across different ages (3- to 8 yrs.-of-age) would demonstrate an alteration in their motor strategies if they were simultaneously engaging in an attention task. A secondary hypothesis of this study was that there is an underlying deficit …

Assessment Of Physical Performance In Adolescents Of Varying Body Weight, Nicholas Dalonzo, Nicole Liquori, Nicole Savarese

Dissertations, Theses, and Capstone Projects

Fifty-one healthy adolescents of both gender without any neuromuscular, musculoskeletal or cardiopulmonary disorders and between the ages of 12 and 17 with a mean age of 14.09 years (SD: 1.45 years) were recruited to participate in the 6-minute walk test. Several measurements such as height, weight and leg length were taken before testing, along with heart rate, blood pressure and oxygen saturation (SPO2) before, after and 10 minutes post 6-minute walk test. Walk distance was also quantified and used as an outcome measure. The adolescents were divided into two groups prior to statistical testing. The first group was classified as …

Implications Of Muscle Activation Patterns On Balance In The Elderly, Arielle Bailey, Goldie Baum, Hadassa Radzik, Aruna Woods

Dissertations, Theses, and Capstone Projects

More than one third of adults ages 65 years old and older fall each year in the United States. This can result in trauma, hospital admissions, and potential death. The purpose of this study was to investigate the effects of waist-pull perturbation training on balance in the elderly. There were two experimental groups, elderly non-fallers (n=9) and elderly fallers (n=5) between ages 65-86, and a control group comprised of young, healthy subjects (n=10) ages 21-31. All subjects underwent baseline and post-training measurements using EMG recordings of the tibialis anterior, gastrocnemius, vastus lateralis and semimembranosus. Training was performing using repeated waist-pull …

Effect Of Absent Tactile Sensation On Multi-Digit Coordination Underlying Hand Control, Michael P. Alcorn, Bruce Faulkner, Matthew Macina, Brian Sherman

Dissertations, Theses, and Capstone Projects

We investigated the effect of anesthesia, causing absent tactile sensation feedback, on multi-digit coordination underlying hand control. The purpose of the study is to expand our understanding on the essential role of tactile sensation feedback in the sensorimotor integration process by examining the motor coordination patterns during multi-digit forces production tasks. We hypothesized that absent tactile sensation feedback would interrupt the force sharing pattern at local and non-local digits. Twelve participants were utilized for data collection and statistical analysis (25.6 ± 4.1 years old, 6 males and 6 females), right-handed (according to their preferred hand use for writing and eating) …

Investigating The Effects Of Combining Treadmill Training With Trans-Spinal Direct Current Stimulation On Motor Skill Recovery After Spinal Cord Injury, Jennifer Blake, Rebecca Bullen, Jeremy Pahl, Samantha Scicchigno

Dissertations, Theses, and Capstone Projects

This study assessed the effect of treadmill training with or without trans-spinal direct current stimulation on motor recovery following a T13/L1 spinal cord hemi section in CD-1 mice. Mice all received the same spinal cord injury, which resulted in left hind limb paralysis, and were assigned to one of three groups. Control animals received no treatment. Treadmill only mice were treated with 5 sessions of treadmill training. Treadmill + stimulation animals were treated with concurrent treadmill training and trans-spinal direct current stimulation. Progress was assessed by analyzing each subject’s steps on a horizontal ladder test, which the animals performed both …

The Effects Of Cooling During Gait On Gait Endurance In Persons With Multiple Sclerosis Using The Six Minute Walk Test, Meghan Higgins, Esther Sosowsky, Elisheva Zinberg

Dissertations, Theses, and Capstone Projects

Background: Persons with MS (pwMS) are limited in their mobility due to thermosensitivity. Exercising at a sufficient volume and intensity to increase mobility can result in increased core temperatures and resultant worsening of symptoms. The use of cooling garments to lower core temperature has been found to be a successful means of allowing pwMS to exercise for longer periods. Previous studies have relied on precooling for an extended period of time prior to activity, to achieve improved exercise performance. Cooling during the performance itself, or pericooling, may allow for similar performance gains to be realized without spending the time needed …

Dancer Performance On The Lower Quarter Y Balance Test: A Longitudinal Study, Megan Dehey, Kelly Kaems, Molly Saunders, Gabrielle Schneider

Dissertations, Theses, and Capstone Projects

Purpose: There is a need in the current literature for further information regarding dancer performance on the Y Balance Test (YBT). This study tracked the test scores of a group of dancers to assess change over time and relationship of balance scores to injury risk. It is hoped that clinicians may be able to use the information found in this study to more accurately screen dancers for asymmetries, deficits, and changes over time using the YBT. Such screenings would allow for more effective care and better assessment of readiness to return to dance. Method: A group of 12 dancers between …

The Effects Of Maximal Strength Training On Gait And Balance In Persons With Multiple Sclerosis: A Pretest Posttest Pilot Study, Janet Klein, David Park, Charles Wright, Michael Zervas

Dissertations, Theses, and Capstone Projects

Background: Physical Therapy strength training programs utilizing mild to moderate intensity are commonly prescribed to address many of the deficits found in multiple sclerosis, but studies examining the effectiveness of higher intensity strength training in gait and balance have not been performed. Maximal strength training (MST), which involves lifting nearly maximal weights (85-95% of an individual’s one repetition maximum [1RM]) with low repetitions, has been shown to improve functional abilities in both healthy and non-MS impaired populations. The higher intensity training used in MST may result in greater activation of the CNS, providing a greater stimulus to improvement than …

Interactions Between Descending And Somatosensory Inputs In Humans, Lisa Krivis, Ann Mackey, Maureen Mcdonough, Denise Uttaro

Dissertations, Theses, and Capstone Projects

In this study, we assessed the corticospinal integration in healthy people while seated. Corticospinal integration was assessed by establishing the latency and amplitude of motor evoked potentials (MEPs) evoked following transcranial magnetic stimulation (TMS) of the primary motor cortex area representing the leg muscles, and the latency and amplitude of spinally-mediated reflex responses. Further, the modulation pattern of the spinally-mediated reflex responses were determined following subthreshold and suprathreshold TMS. All compound muscle action potentials, descending motor or spinally-mediated reflexes were recorded from the leg muscles through surface electromyography. Both subthreshold and suprathreshold TMS induced a similar modulation pattern on the …

An Electromyographic Comparison Of The Functional Performance Of The Gluteus Maximus Muscle In Prolonged Sitting Versus Standing Populations, Kerry Campagnola, Giusi Gerbino, Erica Johnson, Adrienne O’Keefe

Dissertations, Theses, and Capstone Projects

PURPOSE: A common clinical concern of Physical Therapists is the inexplicably weak gluteus maximus (GM) muscle; we hypothesized that this may be linked to the popular habit of prolonged sitting. The purpose of this study was to determine if surface electromyography (sEMG) output and timing of the GM and hamstrings muscles differed between people who sit for prolonged periods of time and people who stand for prolonged periods of time. METHODS: The design of our study was a single session case-control study. Subjects were 22 healthy adults (23-36 years old) who either sat or stood for 8-10 hours a day …

Use Of The Bioness L300® Functional Electrical Stimulator In Acute Stroke Rehabilitation, Christine Flanigan, Colleen M. Martinez, Beth N. Terranova, Nicholas Wildi

Dissertations, Theses, and Capstone Projects

Purpose. Over 150,000 people in the U.S. every year experience foot drop following a stroke, slowing their ambulation and increasing their falls risk. We explore whether the use of functional electrical stimulation (FES) to the common fibular nerve during acute rehabilitation can maximize ambulation gains. Methods. Five in-patients admitted at Burke Rehabilitation Hospital experiencing foot drop participated. While receiving conventional physical therapy, four subjects wore the Bioness L300® device, and one subject used an elastic figure-8 wrapped elastic bandage. Gait parameters were evaluated at initial evaluation, an intermittent evaluation, and discharge. Results. During their stay, subjects significantly improved in gait …

Retrospective Chart Review Of Patients Following Unilateral Total Knee Replacement To Assess Achievement Of Functional Milestones Based On Type Of Anesthetic Used Intra-Operatively, William S. Benish, Lolline Chong, Elana Kram, Danielle Krieger

Dissertations, Theses, and Capstone Projects

PURPOSE: Given the large number of Total Knee Replacements (TKR) performed annually in the US and the prediction that those numbers will increase, providing optimal analgesia during TKR is an important strategy for reducing cost and improving patient outcomes. Currently, no standard analgesia protocol for TKR exists and facilities in the US and world-wide use varied methods of analgesia. The purpose of the present study is to determine which analgesic technique; femoral nerve block (FNB), saphenous nerve block (SNB) or periarticular injection (PAI), within the context of a multi-modal pain management regimen, results in optimal TKR patient outcomes and achievement …

The Influence Of Forward Head Posture On Suprahyoid Activity During Oropharyngeal Swallowing: A Surface Electromyographic Analysis, Brianne Carroll, Sierra Hunt, Katherine Sheeleigh, Mark Wnukowski

Dissertations, Theses, and Capstone Projects

STUDY DESIGN: Within subjects repeated measures design.

OBJECTIVE: The aim of this research is to explore the effect that Forward Head Posture has on the mylohyoid muscle during swallowing in a healthy population.

BACKGROUND: Forward Head Posture (FHP) is the most common deviation from ideal head posture, and has become more prominent due to the rise of smart phones and the prevalence of computers in the household and workplace. FHP is associated with a variety of detrimental effects on the musculoskeletal system that arise from the abnormal positioning of the cranial and cervical bones and joints. In particular, the muscles …

The Effects Of Morning Versus Evening Stretching Exercises In Hamstrings Flexibility Gains, Camron Einerman, Emily Eleff, Ana Ilijeska, Aliza Zinberg

Dissertations, Theses, and Capstone Projects

Many human physiological functions, including muscle flexibility, exhibit a pattern over a 24-hour period, known as circadian rhythm. Muscle flexibility and its circadian rhythm have been researched, though much more information is needed, especially regarding the hamstring muscle group. The object of this study was to determine if stretching at different times of the day results in differences in hamstring flexibility. Since muscles and joints are most flexible at night, greater ranges of motion should be available, allowing for a greater degree of stretching to take place. We hypothesize that when utilizing the optimal type, duration, and frequency of stretch, …

Influences Of Motor Control Instruction And Taping On Center Of Pressure And Scapulothoracic Kinematics During Reaching For Individuals With Hemiparesis, Michelle De Guzman, Tatyana Farber, Anna Kochanova, Jonathan Lazarus

Dissertations, Theses, and Capstone Projects

Purpose: To determine if application of Kinesiotape™ was able to normalize the overall reaching motion by analyzing both surface electromyographic data and force platform feedback. Design: This study utilizes a case-control design.

Subjects: 5 control and 5 stroke survivors age >40 were recruited for this study through flyers at Burke Rehabilitation Hospital, White Plains, NY.

Methods: Surface EMG electrodes were applied to upper extremity (UE) and lower extremity (LE) muscles and an accelerometer placed on the reaching UE. Subjects stood on a force platform and reached towards a target at shoulder height. The task was repeated 5-7 times with right …

Corticospinal Integration In Healthy Humans, Amanda Asmar, Leandra Manfredini, Kerri Mclean, Christina Scannapieco

Dissertations, Theses, and Capstone Projects

Synchronized arrival of neuronal signals from the periphery and motor cortex has been associated with neuronal plasticity and motor learning. The main objective of this study was to examine neuronal interactions following excitation of descending motor axons from the primary motor cortex (M1) and spinal neuronal circuits via transcranial magnetic stimulation (TMS) and transcutaneous electric stimulation of the spine (tsESS) in 15 healthy humans while seated semiprone. TMS was delivered below or above the resting motor evoked potential (MEP) threshold, for the tibialis anterior (TA) muscle, while tsESS was delivered at the lowest stimulation intensity that evoked responses in most …

Cortical Modulation Of Spinal Reflexes In Healthy Humans, Caitlin Bedell, Joseph Capogrosso, Kristin Thomas, Charlotte Westmoreland

Dissertations, Theses, and Capstone Projects

Considerable evidence suggests that monosynaptic and polysynaptic spinal reflexes are prone to corticospinal inputs. The goal of this study was to establish the cortical modulation of monosynaptic and polysynaptic spinal reflexes in healthy humans. Cutaneomuscular responses were evoked following stimulation of the medial edge of the right foot with a 30 ms pulse train every 10 s via a bipolar electrode and recorded from the ipsilateral tibialis anterior (TA) muscle. Across subjects, medial edge foot stimulation was delivered at 1.2 to 1.5 times the response threshold. The soleus H-reflex was evoked and recorded via conventional methods. The effects of transcranial …

Comparing Nmes Stimulation Intensity At Various Lengths Of The Tibialis Anterior, Brent Brookbush, Maya Hakami, Jennifer Wolff, Amy Zelin

Dissertations, Theses, and Capstone Projects

The purpose of this study was to determine if placement of electrodes at various distances along the Tibialis Anterior muscle belly had a significant effect on the intensity of stimulation needed to evoke a contraction using neuromuscular electrical stimulation (NMES). Twenty subjects between the ages of 21-65 in good health and presented with no precautions to NMES were recruited from the CUNY Hunter College physical therapy department. Two reference lines were drawn on subjects’ legs, one outlining the tibial crest (L1), and another from the most lateral portion of the tibial plateau to the center of the lateral malleolus (L2). …

The Effect Of Tdcs On Cd-1 Mouse Behavior Post Induced Sensorimotor Cortex Injury, Michelle Gardella, Natalia Gozias, Kristina Laktionova, Tricia Roehrig

Dissertations, Theses, and Capstone Projects

The functional topography of the motor cortex has been shown to be modifiable by transcranial direct current stimulation (tDCS). tDCS works by directing electrical currents into the brain which induces alterations in neuroplastic cortical excitability. This experiment’s aim was to test the effect of tDCS on recovery of skilled locomotion, recovery of balance, and recovery of grip strength after bilateral electrolytic lesions to sensorimotor cortices in mice. Tests employed in this experiment included the ladder test, grip test, and a balance pole test. We were able to show that 4 days of tDCS post brain injury in mice produced improvements …

Comparison Of An Intermittent Vs. Continuous Walking Program In Persons With Multiple Sclerosis Using The 6 Minute Walk Test: A Randomized Crossover Pilot Study, Stefanie Dicarrado, Bridget Dungan, Elizabeth Huallpa, Jacob Potrzeba

Dissertations, Theses, and Capstone Projects

Background: Difficulty with gait is one of the most common complaints of persons with MS (pwMS) and can be due to many causes, including neurogenic fatigue. Neurogenic fatigue is one of the most common MS symptoms, and can prevent pwMS from walking longer distances, thus limiting their ability to improve gait endurance. Intermittent walking, a technique where persons take breaks during walking rather than walking continuously, may allow for pwMS to walk longer distances due to less accrual of fatigue.

Objectives: The purpose of this pilot study was to examine whether a program of intermittent walking will result in a …

The Long-Term Effects Of Low Level Laser Therapy (Lllt) Combined With Complex Decongestive Therapy (Cdt) In The Treatment Of Breast Cancer Lymphedema: A Double-Blind, Randomized, Placebo-Controlled Study, Olivia Bramlett, Igor Daysudov, Toshi Odaira, Bethany Rodriguez

Dissertations, Theses, and Capstone Projects

Complex Decongestive Therapy (CDT), the gold standard for lymphedema treatment, fails to demonstrate long-term efficacy. The purpose of this study was to determine the long-term efficacy of low level laser therapy (LLLT) in reducing post-mastectomy lymphedema when used with CDT. The experimental group received LLLT and CDT (n = 7) while control group received sham laser and CDT (n = 7), twice a week for 4 to 8 weeks. Percent arm circumference difference between affected and unaffected limbs was collected over 18 months. Results revealed no statistical difference between both groups at all time periods: 1 (p = 0.902), 2 …

Falls Prevention Training At New York Presbyterian Hospital: Does Education Regarding Fall Prevention Reduce Incidence Of Falls After Discharge To Home From An Acute Rehabilitation Facility?, Yuning Chiu, Michelle Frager, Hyunseok Lee, Solange Wong

Dissertations, Theses, and Capstone Projects

The objective of this study was to determine the compared effectiveness of different instruction types for fall prevention training in an inpatient rehabilitation setting based on 6-month falls incidence. This study included 89 English-speaking patients aged 18-90 who participated in a fall prevention training program at New York Presbyterian Hospital’s inpatient rehabilitation center. Patients were divided into two class types, a group or an individual class. Both classes were subdivided into with and without a caregiver. A 10-Meter Walk Test, the Montreal Cognitive Assessment (MoCA), and admission and discharge Functional Independence Measure (FIM™) scores were recorded for baseline comparisons among …