Medicine and Health Sciences Commons^™

Inter-Rater Reliability Of Lumbar Segmental Instability Tests And The Subclassification, Faisal Mohammad Alyazedi

Loma Linda University Electronic Theses, Dissertations & Projects

Objectives: This study investigated the inter-rater reliability of three structural end-range lumbar segmental instability tests with the highest positive Likelihood Ratio against flexion-extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilization exercises in patients with recurrent or chronic low back pain (R/CLBP). It also investigated the reliability of lumbar segmental instability subclassification as: Functional, Structural and Combined Instability. Method: 40 adult with R/CLBP patients (30 men and 10 women), 18 to 80 years of age, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability. Results: Other than the Lack …

Sleep-Wake Cycle Assessment In Type 2 Diabetes And Salivary Melatonin Correlates, Paula Regina Aguiar Cavalcanti

Loma Linda University Electronic Theses, Dissertations & Projects

p=.047). Additionally, there were significant inverse relationships between melatonin collected at two hours before bed time and latency (ρ=-.87; p=.001), wake after sleep onset (ρ =-.69; p=.02) and nocturnal activity (ρ =-.67; p=.03). Latency was inversely correlated with melatonin collected at bed time (ρ =-.69; p=.02). These findings suggest that T2DM presents disturbances in the homeostatic and circadian drives, mainly characterized by less consistency across days of the daily circadian signal, higher rhythm fragmentation and lower rhythm amplitude. In addition to the lower melatonin levels, the decrease in the amplitude of the activity rhythm may also be involved in circadian …

Anterior Cruciate Ligament Elasticity And Force For Knee Flexion During The Menstrual Cycle In Women, Haneul Lee

Loma Linda University Electronic Theses, Dissertations & Projects

Numerous studies have been conducted on changes of knee ligament laxity during the menstrual cycle (MC) since there are more injuries in certain phases. Some researchers believe that since estrogen receptor β exists in ligaments and tendons in the knee, estrogen may modulate towards a state of laxity. However, increased tissue temperature also observed during the MC can predispose ligament and tendon laxness. The number of women using oral contraceptive pills (OCP) has constantly increased in the United States. This exogenous source of synthetic forms of steroid hormones prevents ovulation by maintaining more consistent daily hormone levels than occurs. Since …

Effect Of Passive Vibration On Skin Blood Flow In Good Glycemic Control And Poor Glycemic Control Type 2 Diabetics, Kanikkai Steni Balan Sackiriyas

Loma Linda University Electronic Theses, Dissertations & Projects

Microcirculation regulated by the sympathetic system and vascular endothelium plays a significant role in the homeostasis of temperature and wound healing. Damage to the autonomic nervous system and endothelial system resulting from aging and diabetes decreases the potential of wound healing. Insulin resistance and impaired wound healing associated with type 2 diabetes can lead to diabetic foot ulceration (DFU). Factors such as the increased insulin resistance, impaired wound healing and DFU can increase the risk of amputation in type 2 diabetics (T2D). In research, passive vibration (PV) was effective in increasing skin blood flow (SBF) in healthy individuals as well …

Co-Diagnosis Frequency Of Peripheral Vestibular Disorders And Physical Therapy, Summer M. San Lucas

Loma Linda University Electronic Theses, Dissertations & Projects

Dizziness is among the most common reasons that people consult a physician. The two most common causes of dizziness related to peripheral vestibular dysfunction are benign paroxysmal positional vertigo (BPPV) and vestibular hypofunction (VH). Physical therapy (PT) is an effective component of the medical management for both conditions. The occurrence rate of concurrent BPPV and VH in the same patient has not been described in the literature. Identifying patients with co-diagnosis of BPPV and VH will allow the PT to construct a proper treatment sequence. We conducted a retrospective chart review of 500 consecutive medical records of Veteran's Administration male …

Postural Sway, Eeg And Emg Analysis Of Hip And Ankle Muscles During Eight Balance Training Tasks, Yuen Yi Florence Tse

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to examine postural sway, cortical response and muscle activation of the hip and ankle muscles during eight balance tasks routinely used in sensorimotor training. This was a single group repeated measure study. The postural sway; the power of alpha, beta and sigma wave bands; and the EMG activity of gluteal maximus, gluteal medius, tibialis anterior and medial gastrocnemius were measured in 17 subjects during eight balance tasks with eyes open or closed, feet in tandem or apart and on foam or a firm surface. The results of this study showed that postural sway, EEG …

Effect Of A Single High-Fat Meal And Vitamins On The Circulatory Response To Local Heat In Koreans And Caucasians, Jongeun Yim

Loma Linda University Electronic Theses, Dissertations & Projects

Blood flow mediated by the vascular endothelium plays an important role in removing heat from the skin. Asians who have thrifty genes have impaired endothelial function (EF) due to the westernized high fat (HF) dietary lifestyle. Hypertriglyceridemia (HTG) can produce free radicals which reduces the bioavailability of the endothelium derived relaxing factor, nitric oxide (NO). EF, as measured by the blood flow response (BFR) to heat, occlusion and the free radical concentration after a single HF meal has not been studied in Korean-Asians compared to Caucasians. The purpose of this study was to evaluate baseline and postprandial EF as related …

Virtual Reality Gaming As A Tool For Rehabilitation In Physical Therapy, Abel A. Rendon

Loma Linda University Electronic Theses, Dissertations & Projects

Balance control decreases in the elderly and currently 33 to 50 percent of people over 65 years of age experience a fall each year resulting in ten thousand deaths annually. Many balance‐training programs use expensive equipment and a clinical setting for the training. The need for reliable and low cost tools is essential for fall prevention and rehabilitation of the aging population. Virtual reality gaming is emerging as a solution for this problem. The purpose of the six week study was to determine the effects of virtual reality gaming, specifically the Nintendo Wii Fit Balance Board (WBB), on dynamic balance …

Aerobic Exercise And Bone Turnover In Trained And Untrained Premenopausal Women, Michelle Prowse

Loma Linda University Electronic Theses, Dissertations & Projects

Regular weight-bearing exercise is recommended for healthy young adults to optimize bone mineral density (BMD) (Physical Activity Guidelines Advisory Committee, 2008). BMD alone however, is not a significant predictor of osteoporosis or fracture risk. While bone turnover markers are used clinically to assess efficacy of pharmacological intervention in individuals diagnosed with osteoporosis, they may also have a role in evaluating acute responses to exercise. The purpose of this dissertation was to compare two groups of premenopausal women, those which are sedentary (low fitness) versus those that are well-trained (high fitness), by BMD and bone turnover markers at rest and the …

Effect Of 3-Electrode Electrical Stimulation On Current Delivery And Healing In Chronic Wounds, Hyejin Suh

Loma Linda University Electronic Theses, Dissertations & Projects

Chronic wounds have been an enormous burden on the healthcare system due to their prevalence and the lack of efficacy of current treatment modalities. Over the years, electrical stimulation (ES) has been widely used in the treatment of wounds. Unfortunately, the effectiveness of this treatment is under scrutiny, since many studies have failed to report successive and/or consistent effects of ES on wound healing. This inconsistency may be due to the uneven current produced by the conventional 2-electrode delivery system (2-channel ES) and the reduced resting blood flow resulting from thermally cool treatment rooms. In this study, a new approach …

Is Electrical Stimulation A Predictive Tool For Autonomic Dysfunction In Males With Diabetes?, Susan Dorothy Rand

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to examine whether electrical stimulation can be used as a predictive tool to assess autonomic dysfunction in males with diabetes. The study was designed to better understand the extent of autonomic nervous system (ANS) dysfunction in the diabetic population.

Controls and patients with diabetes were recruited from the community at large and the Loma Linda University Diabetes Treatment Center and were managed by a physician. Twelve (12) people with diabetes and thirteen (13) control subjects participated. Mean age (years) for people with diabetes was 52.4 +/- 6.1 and 47.2 +/-11.1 for controls (p =0.05). …

Physiological Effects Of Vibration In Select Populations, Colleen S. Maloney-Hinds

Loma Linda University Electronic Theses, Dissertations & Projects

Recently, researchers have demonstrated that Whole Body Vibration results in significant increases in skin blood flow. No study has determined if there is an optimal frequency or duration for optimizing this response. In addition, there is no known mechanism for the increase in skin blood flow. It is hypothesized that nitric oxide (NO) is responsible for the increase in skin blood flow due to its ability to vasodilate the smooth muscle in response to shear stress. Therefore, the purpose of this research was to determine the optimal frequency and duration of vibration and determine if NO is the mechanism for …

Isokinetic Knee Strength In Females With Fibromyalgia, Flora F. Shafiee

Loma Linda University Electronic Theses, Dissertations & Projects

Objectives: To compare knee flexors and extensors muscle strength, total work, and power between females with fibromyalgia (FM) and matched healthy controls.

Methods: This is the first study to measure knee muscle power and total work in females with FM. Thirty-one females with FM and thirty-one healthy females completed isokinetic testing of knee flexors and extensors of their dominant leg using a Cybex Norm Isokinetic Dynamometer. Two knee muscle groups (flexors and extensors) at two angular velocities (607sec and 1807sec) were tested for both groups. Both muscle groups were assessed continuously using five reciprocal concentric-concentric cycles, followed by five eccentric-eccentric …

The Effect Of Electrical Stimulation On Blood Flow In Chronic Wounds In Patients With And Without Diabetes, Daryl J. Lawson

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Only 3% of the U S population is afflicted by diabetes, yet one of the most common chronic wounds is the diabetic ulcer. Decrease in blood flow may be one reason why only 31% of neuropathic diabetic ulcers heal in 20-weeks. The purpose of this investigation was to compare healing rates and blood flow of chronic stage III and IV wounds in people with diabetes and those without diabetes over four weeks of treatment. Blood flow was measured before, during, and after stimulation using one of two different electrical stimulation waveforms in a 32°C room.

Subjects …

The Effect Of Posterior Versus Anterior Glide Joint Mobilization On External Rotation Range Of Motion Of Patients With Shoulder Adhesive Capsulitis, Andrea J. Johnson

Loma Linda University Electronic Theses, Dissertations & Projects

Study Design: Repeated measures, randomized comparison of two treatment groups.

Objective: To compare effectiveness of two manual therapy procedures, posterior and anterior glide joint mobilization, for improving external rotation in patients with adhesive capsulitis of the shoulder.

Background: Joint mobilization procedures are often used by physical therapists to treat the accessory motion impairments associated with shoulder adhesive capsulitis. However opinions differ regarding the value of posterior versus anterior glide mobilization. especially for improving external rotation.

Methods and Measures: Subjects with idiopathic adhesive capsulitis exhibiting a specific external rotation range deficit, were randomly assigned to one of two treatment groups. For …

Difference In Transverse Plane Scapular Position Of Professional Baseball Players Relative To Baseball Field Position, James M. Syms

Loma Linda University Electronic Theses, Dissertations & Projects

The objective of this study was to identify the variation of the scaption angle of professional baseball players among field position played. Subjects consisted of 109 minor league professional baseball players reporting for the 2002 spring training season, who were under contract with the Anaheim Angels professional baseball organization. Subjects reported to a sports medicine/physical therapy clinic for their 2002 spring training pre-participation physical examination. The scaption measurements were taken as a component of the examination.

Goniometric measurements were taken with the players in a relaxed standing position. Players were instructed to remain looking forward, roll their shoulders forward three …

The Effect Of Positioning On Pelvic Floor Muscle Activity As Evaluated With Surface Electromyography In Normals, Karen R. Whitter-Brandon

Loma Linda University Electronic Theses, Dissertations & Projects

Physical therapists who treat patients with urinary incontinence commonly utilize sEMG biofeedback. Practitioners compare resting tone, maximal contraction, and muscle endurance measures before and after pelvic floor exercise instruction to determine intervention and demonstrate progress. There is little research that supports the use of biofeedback in positions other than supine. The purpose of this study was to examine the effect of positioning on pelvic floor muscle activity as measured by surface electromyography (sEMG) in supine, sitting, and standing. Subjects were healthy nulliparous and multiparous women, 23-74 years old, with no symptoms, history, diagnosis, or treatment of incontinence. Subjects were randomized …

Orthopedic Treatment Outcomes And Physical Therapists' Orthopedic Clinical Specialist Status, Karin Granberg

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Orthopedic Clinical Specialist (OCS) certification has been available since 1989, however, no prospective studies exist demonstrating better patient outcomes with OCS certification. The purpose of this study was to prospectively explore if there are differences in effectiveness as measured by health, work status and patient satisfaction; efficiency, as measured by visits, treatment duration, number of treatment codes and cost; value (unit of functional improvement per dollar charged), and utilization (unit of functional improvement per visit) depending on OCS status of PTs working in orthopedic outpatient settings.

Subjects. Six PTs with OCS certification and 11 PTs without …

The Effectiveness Of A Physical Therapy Intervention For Children With Hypotonia And Flatfeet, Charmayne G. Ross

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine the effectiveness of physical therapy using Cascade orthotics and an exercise program for children with hypotonia and flatfeet. Subjects: Thirty-seven children, aged 18 months to 5 years, who demonstrated developmental delays and hypotonia with flatfoot dysfunction, participated in this study. Methods: Three groups (control, orthotic, and orthotic-exercise) were studied. The orthotic- exercise group practiced bilateral heel lifts besides wearing the orthoses. An arch index was used to assess the width of the medial longitudinal arch (MLA) pre/post interventions. Gait parameters (velocity, step-length, single-limb support, and cadence) were assessed four times in …

The Role Of Health Promotion In Physical Therapy, Brenda L. Rea

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to investigate physical therapy practice patterns in four focus areas of Healthy People 2010 (focus area #6, disability and secondary conditions by looking at psychological well-being; focus area #19, nutrition and overweight; focus area #22, physical fitness and activity; focus area #27, tobacco use) and identify self-efficacy and outcome expectations related to those practice patterns across California, New York and Tennessee using Bandura’s Social Cognitive Theory as a framework. It was hypothesized that physical therapists’ self-efficacy and outcome expectations in the four focus areas of Healthy People 2010 would be significantly associated with …

Predicting Sacroiliac Syndrome: The Association Between Noninvasive Sacroiliac Joint Tests And Sacroiliac Joint Injections, Lorraine D. Webb

Loma Linda University Electronic Theses, Dissertations & Projects

Study Design. A prospective single sample observational design was performed. Sacroiliac tests that predicted ≥ 75% pain relief after sacroiliac joint (SIJ) injection were considered valid diagnostic tests for SIJ syndrome.

Objectives. To identify valid noninvasive sacroiliac tests that can be used to diagnose SIJ syndrome.

Summary of Background Data. The criterion standard for diagnosing SIJ syndrome is with SIJ intraarticular injections under fluoroscopy. This procedure is costly, invasive, and impractical for routine use. Clinicians need practical ways to diagnose SIJ syndrome; however, few studies have been performed to validate existing sacroiliac tests against SIJ Injections.

Methods. Nineteen subjects …

Effect Of Electrode Size, Shape, And Placement On Electrical Current And Subject Comfort During Electrical Stimulation, Bonnie J. Forrester

Loma Linda University Electronic Theses, Dissertations & Projects

Six healthy subjects were studied to determine the optimal size, shape and placement of stimulating electrodes during the application of electrical stimulation (ES) to the biceps, quadriceps, and tibialis anterior muscles. Subjects were recruited to allow for diversity in age, sex, and skin pigmentation. Subjects sat in a custom designed multi-positional chair, which allowed precise positioning of each extremity. After determining the maximal voluntary contraction (MVC) of the muscle and careful determination of the motor point, ES, with a biphasic square wave of 300 ms duration and a frequency of 30 Hz, was used to bring the muscle to 10% …

Patterns Of Scholarly Productivity In Physical Therapy Faculty, Ardith L. Williams-Meyer

Loma Linda University Electronic Theses, Dissertations & Projects

Due to the proliferation of entry-level doctorate physical therapy programs (DPT), there are two important qualifications for current physical therapy educators: 1) they should hold academic doctorate degrees and 2) they need to conduct scholarly activity, such as research, to increase the scientific base for physical therapy practice. In order to determine current faculty preparation for the increasing number of DPT programs, this descriptive study compared the current percentage of doctorally prepared faculty teaching in entry-level doctorate and masters degree programs, and determined their contributions through original research, publications as first or contributing authors or presentations, during the last five …

Prevalence Of Various Upper Extremity Disorders In Patients With Carpal Tunnel Syndrome Versus Patients Without Carpal Tunnel Syndrome, Daniel C. Buda

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose: Increasingly larger numbers of patients present with repetitive strain injuries of the upper extremities, especially carpal tunnel syndrome (CTS). A large number of these patients appear to have more than one upper extremity condition. The purpose of this study was to determine the probability that a patient diagnosed with carpal tunnel syndrome will also be diagnosed with other upper extremity and/or cervical spine disorders.

Subjects: A group of 188 subjects diagnosed with carpal tunnel syndrome and a group of 203 subjects without carpal tunnel syndrome were selected through a chart review of patients at Loma Linda …

A Practice Analysis Survey: Defining The Clinical Practice Of Primary Care Physical Therapy, Edsen Bermudez Donato

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Due to changes in the health care delivery systems, physical therapy services have moved toward a primary care model of practice. The purpose of this study was to identify the professional responsibilities, procedures, and knowledge areas of physical therapists practicing in primary care settings.

Subjects. A sample of 212 physical therapists practicing in primary care settings, and a control group of 250 physical therapists not practicing in primary care settings were surveyed.

Methods. The survey instrument was developed with the assistance of a National Advisory Committee (NAC) consisting of 12 subject matter experts. A modified Delphi …

The Effects Of Education On Fear-Avoidance Behavior Of Subjects With Work-Related Low Back Pain, Marie A. Anger

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Fear-avoidance behavior contributes to chronic low back pain. The purpose of this study was to determine whether patient education on fear-avoidance behavior added to conventional physical therapy would have significant effects on return to work status in contrast to a comparison group with only physical therapy intervention. Return to work status was measured by the length of time from the initial injury to the subject’s return to work on regular duty.

Subjects. Thirty-four workers’ compensation subjects with low back pain who exhibited fear-avoidance behavior, according to their responses to the Fear- Avoidance Beliefs Questionnaire, were alternately assigned …

Disability Self-Assessment And Upper Quarter Muscle Balance In Females, Eric Glenn Johnson

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. This study compared upper quarter muscle balance of working female dental hygienists and non-dental hygiene females who had no history of upper quarter pathology. The upper quarter was operationally defined as the shoulder and neck region; and muscle balance, as muscular flexibility and muscular performance. Muscular performance was operationally defined as a combination of strength and endurance.

Subjects. The study group consisted of 41 working dental hygienists between the ages of 22 and 60 years with a mean age of 38 years. The control group consisted of 46 non-dental hygienists between the ages of 20 and 54 …

Factors In Predicting The Number Of Home Care Physical Visits, Bruce D. Bradley

Loma Linda University Electronic Theses, Dissertations & Projects

There has been a significant increase in the utilization of home health care during the past decade. Medicare has attempted to control home care costs by 1) allowing Medicare beneficiaries to join Health Maintenance Organizations, and 2) requiring the use of the Outcome and Assessment Information Set (OASIS) for all patients admitted to home care services. These changes have challenged the home care physical therapist to be a better predictor of the total number of visits needed to complete the rehabilitation process. This was a retrospective study of 335 patients who received home health care physical therapy. The first part …

Toward The Optimal Waveform For Electrical Stimulation, Scott Douglas Bennie

Loma Linda University Electronic Theses, Dissertations & Projects

Electrical stimulation (ES) is used to strengthen muscle, improve abnormal tone, and improve the healing rate of pressure sores. Four male and three female research subjects received four minute bouts of electrically stimulated isometric contractions equal to 10% of the maximal voluntary contraction (MVC) of their right quadriceps muscle to study subjective comfort and physiological responses to different waveforms, including Russian, interferential, sine, and square. Frequency remained constant at 30pps. The pulse width for the Russian waveform was 200ps, while the sine, square, and interferential waveforms used a lOOps pulse width. The amplitude of stimulation was adjusted to maintain the …

Comparison Of Elderly Non-Fallers And Fallers On Performance Measures Of Functional Reach, Sensory Organizations, And Limits Of Stability, Harvey W. Wallmann

Loma Linda University Electronic Theses, Dissertations & Projects

OBJECTIVE: The purpose of this study was to compare elderly non-fallers and fallers for differences in the following: (1) mean functional reach (FR), (2) mean anterior limits of stability (LOS), (3) mean posterior LOS, and (4) mean sensory organization test (SOT) composite score. The following correlations were tested for significance separately in the sample of non-fallers and the sample of fallers: (1) FR and anterior LOS, (2) FR and posterior LOS, (3) FR and SOT composite score, (4) anterior LOS and the SOT composite score, and (5) posterior LOS and the SOT composite score.

DESIGN: Two group comparison design.

SETTING: …