Medicine and Health Sciences Commons^™

Diagnosis Of Internal Carotid Artery Stenosis In A Patient Referred To A Physiotherapist For Dizziness, Ryan Boggs, Michael Ross, Michael Tall

Articles & Book Chapters

PURPOSE: The purpose of this report is to describe the diagnostic focus of the clinical decision-making process for a patient referred to a physiotherapist for treatment of persistent dizziness, who was subsequently diagnosed with severe stenosis of the internal carotid arteries.

CASE DESCRIPTION: The patient was a 79-year-old man who was referred to a physiotherapist by his primary care physician for the treatment of persistent intermittent dizziness. The patient’s dizziness began 6 months prior insidiously; it was worsening over time and now interfered with activities of daily living. The patient denied cervical pain or headaches, numbness or tingling in his …

Anterior Talofibular Ligament And Superior Extensor Ankle Retinaculum Thicknesses: Relationship With Balance, Brooke Malloy, David Furrow, Haily Cook, Elizabeth Smoot, Lindsey Cash, Adrian Aron, Kristen Jagger, Brent Harper

Physical Therapy Faculty Articles and Research

Purpose

This study determined if anterior talofibular ligament (ATFL)/superior extensor ankle retinaculum (SEAR) thicknesses are related to dynamic balance in individuals with chronic ankle instability (CAI).

Materials and Methods

The subjects were 14 males and 15 females (age=24.52±3.46 years). Ankle instability was assessed using the Cumberland Ankle Instability Tool (CAIT) with a cut off score of 25 to define two groups. SonoSite MTurbo (Fugifilm Sonosite, Inc.) musculoskeletal ultrasound (MSKUS) unit was used to assess ATFL and SEAR thicknesses. Dynamic balance was measured with the Y Balance Test (YBT) and two NeuroCom balance tests.

Results

There were no significant differences in …

Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young

Case Report Papers

Background and Purpose: The main focus of chronic disease in healthcare has typically been about treatment of the disease itself, with little attention given to secondary injuries that result from the chronic disease process. As these individuals age, the risk of secondary injuries increases. This is costly and adds to the caregiver burden. The purpose of this case report was to investigate a comprehensive physical therapy (PT) program focused on rehabilitation for a female with chronic disease who sustained a femoral fracture following her most recent fall. Case Description: A 42-year-old female presented to outpatient PT following a right femoral …

Tissue Plasminogen Activator Effects On Stroke And Physical Therapy Outcomes In Acute Care: A Case Report, Lindsey Leboeuf

Case Report Papers

Background and Purpose: An ischemic stroke occurs when blood flow to an area of the brain is restricted and can cause numbness or weakness on one side of the body, facial droop, trouble speaking, and trouble walking. Patients who seek medical attention for symptoms within three hours of their onset can be eligible to receive tissue plasminogen activator (tPA). These patients often have less resultant disability than their counterparts who did not receive the drug. The purpose of this case reports is to display the positive effects of tPA and physical rehabilitation following a stroke in the acute care setting. …

Combining A Comprehensive Physical Therapy Program And Electrocorpeal Shockwave Therapy For Plantar Fasciitis: A Case Report, Kathryn Piersiak

Case Report Papers

Background and Purpose: Plantar fasciitis (PF) is present in 2 million Americans a year, and in 10% of the population over a lifetime. Conventional physical therapy (PT) for PF has included strengthening of foot and hip musculature, and lower extremity stretching. Extracorporeal shockwave therapy (ECSW) has also been utilized with success in treatment of PF. While these two treatments have been used individually, their combined effect has not been studied. The purpose of this case report investigated a combined plan of care utilizing conventional PT, targeted hip strengthening, and ECSW. Case Description: The patient was a 48-year-old female who presented …

Treatment Of A Work-Related Superior Glenoid Labral Repair: A Case Report, Alexandra Touri

Case Report Papers

Background and Purpose: A superior glenoid labrum tear anterior to posterior (SLAP) is a common injury in the shoulder although they are less commonly seen in the workplace. There are many resources for SLAP lesions concerning overhead throwing athletes, however, there are not specific details on return to work rehabilitation activities for the workers’ compensation population. The purpose of this case report is to explore the post-operative physical therapy management of a workers’ compensation patient with a superior glenoid labrum lesion. Case Description: This patient was a 45-year-old Hispanic female diagnosed with a superior glenoid labrum lesion of the left …

A Hip Strengthening Protocol For A Patient Following Achilles Repair: A Case Report, Matthew Morris

Case Report Papers

Background and Purpose: The Achilles tendon is the strongest, yet most frequently ruptured, tendon in the body. Hip strength has been associated with various lower extremity (LE) conditions. However, there is a lack of literature regarding hip strengthening and its impact on Achilles injuries. Therefore, the purpose of this case report was to describe the rehabilitation of a patient following a left Achilles tendon repair utilizing a comprehensive hip strengthening protocol. Case Description: The patient was a 32-year-old female who ruptured her Achilles playing tennis. She underwent surgical repair three weeks later and was immobilized and non-weightbearing for a total …

Restoring Functional Mobility For A Geriatric Patient Following Open Repair Of A Ruptured Abdominal Aortic Aneurysm: A Case Report, Grace Laughlin

Case Report Papers

Background and Purpose: Each year 200,000 people are diagnosed with an abdominal aortic aneurysm (AAA) in the United States and the mortality rate for ruptured AAA is estimated to be 80%. There are two surgical options to treat ruptured AAA, an open repair and an endovascular aneurysm repair (EVAR). The incidence of rupture following an EVAR is 0.9%. The purpose of this case report was to describe the physical therapy (PT) plan of care of an elderly patient following an open repair of a ruptured AAA with a history of EVAR. Case Description: The patient was an 86-year-old female admitted …

Physical Therapy Management Of Low Back Pain In A Young Female With Ankylosing Spondylitis Associated With Hla-B27 Antigen: A Case Report, Jake Adkins

Case Report Papers

Background and Purpose: Ankylosing spondylitis (AS) is a form of arthritis characterized by chronic inflammation of the axial skeletal system that causes back pain and loss of mobility with strong potential for slow, eventual spinal fusion. The condition affects 0.2-0.5% of the United States population. There is no known cure for AS and the cause is unknown. The purpose of this case report is to describe a comprehensive approach for physical therapy (PT) management of AS in order to assist clinical reasoning and clinical decision-making and enhance care management in this patient population. Case description: A 27-year old female referred …

Gait, Strength, And Balance Training For A 43-Year-Old Male Following An Acute Right Middle Cerebral Artery Stroke: A Case Report, Victoria Dwyer

Case Report Papers

Background and Purpose: Although many patients who have had a stroke receive inpatient rehabilitation treatment, there is limited literature that investigates the interventions utilized to treat this population. The purpose of this case study was to describe the inpatient rehabilitation treatment interventions including body weight supported treadmill training (BWSTT), functional electrical stimulation (FES), balance, and lower extremity (LE) strengthening on a patient with a sub-acute right middle cerebral artery (R MCA) stroke. Case description: The patient was a 43-year-old male who recently had a R MCA stroke. He presented with significant expressive aphasia, left-sided hemiparesis, balance and transfer deficits, and …

Functional School-Based Physical Therapy Management For A Child With Pallister-Killian Syndrome: A Case Report, Cheryl R. Espinosa

Case Report Papers

Background and Purpose: Pallister-Killian Syndrome (PKS) is a rare genetic disorder resulting from an additional short arm in chromosome 12. This condition leads to varying levels of multi-system impairments that impact a child’s development in gross motor skills yielding functional limitations. Pediatric physical therapy (PT) management is crucial for these children to facilitate improvements in sitting, standing, and ambulation. The purpose of this case report was to describe functional school-based PT management for a child with PKS. Case Description: The child was a seven-year-old male diagnosed with PKS at 20 weeks’ gestation. The child was seen for PT five times …

Muscle Activation Patterns During Movement Attempts In Children With Acquired Spinal Cord Injury: Neurophysiological Assessment Of Residual Motor Function Below The Level Of Lesion., Darryn A Atkinson, Laura Mendez, Natalie Goodrich, Sevda C Aslan, Beatrice Ugiliweneza, Andrea L Behrman

Physical Therapy Collection

Introduction: Characterization of residual neuromotor capacity after spinal cord injury (SCI) is challenging. The current gold standard for measurement of sensorimotor function after SCI, the International Society for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam, seeks to determine isolated intentional muscle activation, however many individuals with SCI exhibit intentional movements and muscle activation patterns which are not confined to specific joint or muscle. Further, isolated muscle activation is a feature of the neuromuscular system that emerges during development, and thus may not be an appropriate measurement standard for children younger than 6.

Methods: We utilized neurophysiological assessment …

Early Mobilization And Functional Mobility Training For A Patient With Triple Vessel Coronary Artery Bypass Grafting: A Case Report, Cody Hall

Case Report Papers

Background and Purpose: Coronary artery disease (CAD) is the buildup of plaque in coronary blood vessels and is the most common type of heart disease in the United States. Coronary artery bypass grafting (CABG) is an invasive surgical procedure used to provide alternate blood supply to cardiac tissue in individuals with CAD using autografts. The goals of the surgery are often to prolong life, reduce symptoms, improve functioning, and improve vocational status. The purpose of this case report was to document the outcomes of a physical therapy (PT) plan of care for a complex patient after undergoing CABG. Case Description: …

Regaining Independence In Ambulation For A Visually Impaired Patient With Rhabdomyolysis: A Case Report, Brandon Bourgoin

Case Report Papers

Background and Purpose: Rhabdomyolysis is a myopathic condition that causes significant muscle wasting following an acute onset. This condition elevates creatine kinase in the bloodstream, and commonly causes the patient to have muscle pain, swelling, and weakness, as well as dark “tea” colored urine. The purpose of this study was to describe physical therapy (PT) interventions used treating a legally blind (LB) elderly male with rhabdomyolysis and multiple comorbidities. Case Description: A 78-year-old male referred to PT with a diagnosis of rhabdomyolysis following a fall in the home. He presented with muscle soreness, decreased lower extremity (LE) strength, and impaired …

Calcium Pyrophosphate Deposition Disease In The Achilles Tendon, Kai-Yu Ho, Jing Nong Liang

Physical Therapy Faculty Publications

The classic sonographic presentation of calcium pyrophosphate dihydrate crystal deposits in the Achilles tendon is reported.

Characteristics Of Medial-Lateral Postural Control While Exposed To The External Perturbation In Step Initiation, Yun-Ju Lee, Jing Nong Liang, Bing Chen, Alexander S. Aruin

Physical Therapy Faculty Publications

Controllability of posture in the medial-lateral direction is critical for balance maintenance, particularly in step initiation. The objective of the current study was to examine the effects of external perturbation and landing orientation on medial-lateral control stability in step initiation. Eleven young healthy participants stood on the force platform and waited for the instruction of taking a step while experiencing a pendulum perturbation applied at the lateral side of the right shoulder. Eight experimental conditions were conducted by two levels of step side (right or left), two levels of perturbation (with or without), and two levels of landing orientation (forward …

Comparison Of Functional And Patient-Reported Outcomes Between Direct Anterior And Lateral Surgical Approach One-Year After Total Hip Arthroplasty In A Canadian Population: A Cross-Sectional Study., Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward Vasarhelyi, Brent Lanting

Physical Therapy Publications

Background: From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery.

Methods: We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, …

Individuals With Recurrent Low Back Pain Exhibit Significant Changes In Paraspinal Muscle Strength After Intramuscular Fine Wire Electrode Insertion, Szu-Ping Lee, Vincent Dinglasan, Anthony Duong, Russell Totten, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Objective

To examine how insertion and presence of intramuscular fine‐wire electromyography electrodes (IFWE) in lumbar multifidus affect paraspinal muscle strength, endurance, and activation in persons with and without recurrent lower back pain (RLBP) during activities that require high levels of muscle contraction.

Design

Case‐control with randomization of conditions.

Setting

Clinical Research Laboratory.

Participants

Forty participants age 18‐40 were recruited (18 female; mean age = 25.5 yr); 20 with a history of RLBP were compared to a matching control group of 20 without RLBP.

Interventions

Each participant was tested under three conditions over three sessions. On Session 1, the baseline condition, …

Blood Flow Restriction Exercise: A Systematic Review Of The Literature, James M. Mckivigan

College of Health & Human Services (TUN) Publications and Research

Blood flow restriction training is quickly gaining popularity in the United States. However, it is not without controversy. While there are many reported health benefits, there are equally as many risks. Most concerning is the lack of industry standardizations regarding cuff size and pressure. There is no required training to implement blood flow restriction training, which can be problematic when people with little knowledge practice this type of exercise. When blood flow is restricted, there is an impact on the cardiovascular system, nervous system, and muscular system. Damage can be done when blood flow is restricted with too much pressure …

A Global Perspective Of Postural-Related Shoulder Pain (Prsp), Zoe Geiger, Kiley Pinder, Kasey Cottrill, Holly Roberts

Physical Therapy Research Symposium

Background: During a physical therapy service trip to Zacapa, Guatemala, in March 2019, ten of 106 patients were treated for symptoms of PRSP. Their pain was often exacerbated by repetitive work-related tasks performed with poor posture such as doing laundry by hand, carrying loads overhead, manual labor, and childcare.

Methods: A brief review of the literature was performed to determine global differences in PRSP and effective treatment interventions. PubMed, Collins Memorial Library, and Google Scholar were searched using search terms including “postural-related”, “work-related”, “shoulder pain”, and “global”.

Results: Nine full-text articles were retrieved and reviewed. PRSP was reported in Ethiopian …

Autonomic Nervous System Changes In Individuals With Chronic Pain: A Systematic Review Of The Literature, Dr. Karin Steere, Jason Steere Dpt, Kasey Cottrill, Zoe Geiger

Physical Therapy Research Symposium

PURPOSE: The aim of this review was to investigate the relationship between heart rate (HR) or blood pressure (BP) and chronic pain conditions.

BACKGROUND: Treatment of chronic pain has placed enormous economic burden on the healthcare system. Autonomic nervous system (ANS) dysregulation is correlated to chronic pain. One measure of ANS dysregulation is heart rate variability (HRV), and decreased HRV can predict adverse future prognosis in a variety of conditions. While HRV validly measures ANS dysregulation, inexpensive and quicker measurements of HR and BP have been less investigated.

METHODS: Searches in PubMed, Ovid, Google Scholar, and CINAHL were performed using …

Common Experiences And Beliefs Among Highly Active, Older Adults, Alex Knapp Spt, Dominick Post Spt, Danny Mcmillian Pt Dsc

Physical Therapy Research Symposium

Background: Research on correlates and determinants of physical activity has shown that age and motivation are associated with physical activity. Self-Determination Theory (SDT) provides a well-researched framework for understanding motivation, and proposes that the satisfaction of three primary psychological needs: autonomy, competence, and relatedness, fuels motivation for physical activity and promotes wellness.

Purpose: Use SDT to identify experiences and beliefs that affect motivation for physical activity in older adults and provide a narrative approach to share their “movement stories.”

Methods: Participants were recruited using nominated sampling and a public advertising campaign. Participants were at least 55-years old with International Physical …

Demographics And Treatment Strategies Utilized During A Service-Learning Trip To A Medically Underserved Region: Guatemala 2019, Anna Chang, Alex Knapp, Holly Roberts

Physical Therapy Research Symposium

Demographics and Treatment Strategies Utilized During a Service-Learning Trip to a Medically Underserved Region: Guatemala 2019

By Anna Chang, SPT, Alex Knapp, SPT, and Holly Roberts, PT, DPT, GCS, NCS

BACKGROUND: Students in the Global Health Perspectives in Physical Therapy elective at the University of Puget Sound participated in a five-day service-learning trip. They partnered with a host organization to provide physical therapy services in Zacapa, Guatemala.

PURPOSE: Synthesize demographic information and intervention plans to educate physical therapists and students to effectively evaluate and treat medically underserved populations abroad.

METHODS: Age, gender, physical therapy diagnosis, and type of intervention were …

Latent Effects Of Stress On Delayed Modulation Of Chronic Low Back Pain: Case Series, Roger Allen Phd, Pt, Anna Chang Spt, Catherine Mooney-Myers Spt, Lauren Gallison

Physical Therapy Research Symposium

Purpose: The purpose of the study was to investigate the temporal relationship between psychogenic stress and perceived intensity of chronic low back pain (LBP). LBP was chosen as a pilot condition prefacing a larger research effort to determine which variants of chronic pain may manifest latent psychogenic modulation based on previous studies of neuropathic pain conditions.

Methods: The study consisted of five subjects, one male and four females, ranging from 19-32 years old and chronicity of pain ranging from 5 months to 6+ years since diagnosis. Over 12-15 weeks, participants completed daily visual analog pain, stress, and pain-related function scales. …

A Diagnostic Condition And Its Implications [Physical Therapist Assistant Program], May Tom

Open Educational Resources

SCT 101: Introduction to Physical Therapy

Assignment Description: This assignment was designed during Learning Matters 2018-2019 Digital Communication sub-seminar. The assignment was originally a written paper based on the clinical manifestations and pathogenesis of a diagnostic condition. As the profession of physical therapy is inherently a teaching profession, an oral and digital component was incorporated to facilitate the student’s ability and confidence in oral communication and use of media. The presentation of a diagnostic condition and implication in the performance of activities for an individual can be variable depending on the individual’s physical status, medical/health history, and psychosocial status. To …

Energy Cost Of Slow And Normal Gait Speeds In Low And Normally Functioning Adults, Taylor W. Rowley, Chi Cho, Ann M. Swartz, John Staudenmayer, Allison S. Hyngstrom, Kevin G. Keenan, Whitney A. Welch, Scott J. Strath

Physical Therapy Faculty Research and Publications

Objective

Slow walking speed paired with increased energy cost is a strong predictor for mortality and disability in older adults but has yet to be examined in a heterogeneous sample (ie, age, sex, disease status). The aim of this study was to examine energy cost of slow and normal walking speeds among low- and normal-functioning adults.

Design

Adults aged 20–90 yrs were recruited for this study. Participants completed a 10-m functional walk test at a self-selected normal walking speed and were categorized as low functioning or normal functioning based on expected age- and sex-adjusted average gait speed. Participants completed two …

Electroskip Auditory Biofeedback In A Patient With Parkinson Disease: A Case Report, Garrett Szydlowski, Jamie O’Neil, Jon Mrowczynski, Lisa Inglis, Michael Ross

Articles & Book Chapters

The purpose of this case study was to observe the effects of a rehabilitation program with an audio-biofeedback technology device called Electroskip in a patient with Parkinson disease. The patient was a 61-year-old man with moderate Parkinson disease (Hoehn and Yahr Parkinson’s scale stage III) and dementia who had progressive episodes of freezing of gait. The patient also had a history of recent falls. The patient completed a 6-week rehabilitation program focused on functional tasks, balance and gait training while using Electroskip technology, which is a wireless, wearable device that sends a discrete real-time generative audio-biofeedback signal when the user …

Femoral Retrotorsion As The Source Of Sacroiliac Symptoms – A Case Report, Catherine Patla, Kristin Hernandez

Physical Therapy Collection

The presence of femoral retrotorsion limits the ability to functionally utilize internal rotation IR of the hip. Postures which require the internal rotation of the hip can place more stress on the sacroiliac SI area as a compensation. This case report highlights a patient s self management of the SI symptoms by avoiding the postural positions requiring internal rotation. Retrospective analysis shows a significantly higher correlation of femoral retroversion (57%) in patients with these pain descriptors versus asymptomatic patients in whom the incidence of retroversion is only 5-15% (Prather 2019). The purpose of this case report is to demonstrate that …

Neurorehabilitation For An Individual With Bilateral Thalamic Stroke And Preexisting Visual Impairment Presenting With Impaired Use Of Sensory Cues: A Case Report, Christina Kelly, Jen Meyer, Valery Hanks, Christy Barefield

Articles & Book Chapters

Introduction: Impaired balance is one of the primary causes of functional limitations. Related to sensory deficits specifically, balance disorder in stroke may be caused by decreased central integration of sensory cues, including somatosensory, visual and vestibular input.

Case Presentation: This case describes a 23-year-old male with bilateral thalamic stroke following surgical resection of a recurring optic nerve meningioma. He had a complex medical history and is legally blind. He presented to outpatient neurorehabilitation 5 months following his stroke. He demonstrated absent light touch sensation and absent proprioception and kinesthetic awareness in his upper extremities, lower extremities, and trunk. …

Decreased Mobility Of Cuboid Rotation As The Source Of Achilles Tendinopathy--A Case Report, Catherine Patla, Kristin Hernandez

Physical Therapy Collection

Joint mobility is necessary for adequate function of musculature. Internal rotation of the cuboid functions to allow midtarsal and hindfoot pronation in weight bearing. Inability of the cuboid to internally rotate limits mid tarsal pronation, which limits contraction of the gastroc soleus on weight bearing, ultimately contributing to muscle/tendon stress. The continued stress on the contractile structure leads to a tendinopathy which results in limited functional use with pain of the gastroc/soleus. The purpose of this case report is to outline the successful treatment of a patient with this clinical presentation.