Medicine and Health Sciences Commons^™

Perceived Exercise Habits Of Individuals With Parkinson’S Disease Living In The Community, Jordana Lockwich, Kate Schwartzkopf-Phifer, Camille L. Skubik-Peplaski, Richard D. Andreatta, Patrick H. Kitzman

Communication Sciences and Disorders Faculty Publications

Context

Exercise has been shown to improve gait in individuals with Parkinson’s disease (PD). Stepping practice at higher intensity levels has been suggested as a beneficial treatment option to improve gait in the neurological population. Unfortunately, this mode is poorly understood and underutilized within the PD population. Information on what individuals with PD are doing for exercise would be beneficial to help tailor exercise programs to improve gait and provide exercise options in the community for intensity-based exercise.

Objective

To investigate the current exercise habits of individuals living with PD in the community aimed at improving walking and to understand …

Evidence Of Myomir Regulation Of The Pentose Phosphate Pathway During Mechanical Load-Induced Hypertrophy, Taylor Valentino, Vandre C. Figueiredo, C. Brooks Mobley, John J. Mccarthy, Ivan J. Vechetti Jr.

Physiology Faculty Publications

Many of the molecular and cellular mechanisms discovered to regulate skeletal muscle hypertrophy were first identified using the rodent synergist ablation model. This model reveals the intrinsic capability and necessary pathways of skeletal muscle growth in response to mechanical overload (MOV). Reminiscent of the rapid cellular growth observed with cancer, we hypothesized that in response to MOV, skeletal muscle would undergo metabolic programming to sustain increased demands to support hypertrophy. To test this hypothesis, we analyzed the gene expression of specific metabolic pathways taken from transcriptomic microarray data of a MOV time course. We found an upregulation of genes involved …

The Rehabilitation Of A 75-Year-Old Male Presenting With A Right Hip Flexor Strain Concomitant With Numerous Psychosocial Factors: A Case Report, Jillian Battista, Megan Chapski, Suma Varanasi, Jillian Witwicki

Case Report Papers

Background: Musculoskeletal disorders, often well understood, are a leading cause of disability worldwide. Concomitant psychosocial factors add a layer of complexity to the treatment of musculoskeletal disorders. The purpose of this case report is to highlight the potential impact psychological factors have in the rehabilitation of musculoskeletal disorders, specifically the rehabilitation of a right hip flexor strain.
Case Description: The patient was a 75-year-old male referred to outpatient physical therapy for the assessment of a right hip flexor strain, presenting with psychosocial factors including anxiety and kinesiophobia. Procedural interventions included patient education, neuromuscular re-education, therapeutic exercise, and manual therapy, but …

Utilizing An Evidence-Based Practice Framework In Non-Operative Acl Rehabilitation - A Case Report, Eric Norman, Michael Madore, Kathryn Magee, Tyler Calimer, Parker Nally

Case Report Papers

Study Design: Case Report. Background: The patient was a 51-year-old female who tore her left anterior cruciate ligament (ACL) playing pickleball and opted for non-operative treatment. The clinicians involved treated the patient using the three pillars of practice: relevant scientific evidence, clinician experience, and patient perspective.
Treatment: The patient’s treatment consisted of therapeutic exercises, neuromuscular re-education, soft tissue massage, and motivational interviewing. Therapeutic exercises were designed to strengthen the muscles surrounding her hip and knee. Neuromuscular re-education helped to improve the patient’s knee stability and balance, while soft tissue massage was used to decrease swelling. Motivational interviewing helped her better …

Phrenic Afferent Activation Modulates Cardiorespiratory Output In The Adult Rat, Kristi A. Streeter, Michael D. Sunshine, Paul W. Davenport, David D. Fuller

Physical Therapy Faculty Research and Publications

Phrenic afferents project to brainstem areas responsible for cardiorespiratory control and the mid-cervical spinal cord containing the phrenic motor nucleus. Our purpose was to quantify the impact of small- and large-diameter phrenic afferent activation on phrenic motor output. Anesthetized and ventilated rats received unilateral phrenic nerve stimulation while contralateral phrenic motor output and blood pressure were recorded. Twelve currents of 40-Hz inspiratory-triggered stimulation were delivered (20 s on, 5 min off) to establish current response curves. Stimulation pulse width was varied to preferentially activate large-diameter phrenic afferents (narrow pulse width) and recruit small-diameter fibers (wide pulse width). Contralateral phrenic amplitude …

Executive Functions And Student Success During Physical Therapist Education: An Exploratory Study, Jane Roitsch, Martha L. Walker, Anastasia M. Raymer

Communication Disorders & Special Education Faculty Publications

BACKGROUND: Clinical reasoning relies on executive functions (EFs) that manage attention, inhibition, organization, and decision-making. Assessment of EFs may help identify students who excel at clinical reasoning, yet data showing this relationship in physical therapy (PT) education programs are lacking. The primary purpose of this exploratory study was to examine EFs in relationship to success in PT educational programs. METHODS: Thirteen third-year PT graduate students completed two EF tests which were compared to culminating scores in the program and admissions scores. RESULTS: A relationship existed between National Physical Therapy Examination (NPTE) and comprehensive exam results and one EF test score; …

The Effect Of Dual-Task Testing On The Balance And Gait Of People With Lower Limb Amputations: A Systematic Review, Humberto Omana, Edward Madou, Manuel Montero-Odasso, Michael W. Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: To systematically review the literature on the effect of dual-task testing on the balance and gait of people with lower limb amputations (PLLA).

LITERATURE SURVEY: Databases MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus were searched in duplicate (inception to December 1, 2020).

METHODOLOGY: Inclusion criteria: participants were adults with transtibial, knee-disarticulation, transfemoral, or bilateral lower limb amputations; balance or gait was paired with a secondary task; and studies were peer-reviewed and published in English. Two authors independently reviewed articles and consensus was required. A standardized data extraction sheet was used to gather study relevant information in duplicate. …

The Role Of Eye Movements, Attention, And Hand Movements On Age-Related Differences In Pegboard Tests, Brittany Heintz Walters, Wendy E. Huddleston, Kristian M. O'Connor, Jinsung Wang, Marie K. Hoeger Bement, Kevin G. Keenan

Physical Therapy Faculty Research and Publications

Well-documented manual dexterity impairments in older adults may critically depend on the processing of visual information. The purpose of this study was to determine age-related changes in eye and hand movements during commonly used pegboard tests and the association with manual dexterity impairments in older adults. The relationship between attentional deficits and manual dexterity was also assessed. Eye movements and hand kinematics of 20 young (20–38 yr) and 20 older (65–85 yr) adults were recorded during 9-Hole Pegboard, Grooved Pegboard, and a visuospatial dual test. Results were compared with standardized tests of attention (The Test of Everyday Attention and Trail …

Kinematic Assessment Of Turning And Walking Tasks Among Stroke Survivors By Employing Wearable Sensors And Pressure Platform, Masoud Abdollahi, Pranav Madhav Kuber, Christopher Hoang, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Stroke survivors often experience reduced movement capabilities due to alterations in their neuromusculoskeletal systems. Modern sensor technologies and motion analyses can facilitate the determination of these changes. Our work aims to assess the potential of using wearable motion sensors to analyze the movement of stroke survivors and identifying the affected functions. We recruited 10 participants (5 stroke survivors, 5 healthy individuals) and conducted a controlled laboratory evaluation for two of the most common daily activities: turning and walking. Among the extracted kinematic parameters, range of trunk and sacrum lateral bending in turning were significantly larger in stroke survivors (p-value<0.02). However, no statistical difference in mean angular velocity and range of motion for trunk/sacrum/shank flexion-extension were obtained in the turning task. Our results also indicated that during walking, while there was no difference in swing time, double support portion of gait among the stroke group was significantly larger (p-value = 0.001). Outcomes of this investigation may help in designing new rehabilitation programs for stroke and other neurological disorders and/or in improving the efficacy of such programs.Clinical Relevance— This study may provide a better insight on the detailed functional differences between stroke survivors and healthy individuals which in turn could be used to develop a more efficient rehabilitation program for stroke community.

Prediction Of Fall Risk Among Community-Dwelling Older Adults Using A Wearable System, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon, Teresa Wu, Christopher W. Frames, Raven Weaver, Karen A. Roberto

Physical Therapy Faculty Articles and Research

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined …

Enhancing The Patient Experience Through Innovative Quality Improvement Education, Tami Struessel, Betsy J. Becker, Nicole M. Sleddens

Posters and Presentations: Physical Therapy

The “Patient Experience” arm of the Institute for Healthcare Improvement’s Quadruple Aim is defined by the Institute of Medicine (IOM) as quality care that is safe, effective, patient-centered, timely efficient, and equitable. The IOM called for a uniform approach to health professions education utilizing five core competencies to achieve high-quality care. “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Physical Therapy educators have expanded curricula to teach three of these five competencies. We routinely teach that physical therapists practice in interprofessional teams to provide …

Ease-Ing Dpt Students Into The Acute Care Environment, Nicole M. Sleddens, Tessa Wells, Stacie Mae Larreau Christensen, Kellie Clapper, Lora Pieper

Posters and Presentations: Physical Therapy

Purpose: The Early Acute Service Experience program (EASE) is a dual-purpose program that prepares physical therapy students to transition from the academic setting to the acute clinical environment while providing a helpful service to key clinical partners. Methods/Description: This program requirement begins as students are assigned a weekend in the second semester of the DPT curriculum to work with a physical therapist in the hospital. As the first step in their orientation, students complete an e-learning module which focuses on the knowledge, skills, and abilities required in the acute care clinical environment. Once a student has completed the module and …

Criterion Validation And Interpretability Of The Single Assessment Numerical Evaluation (Sane) Of Self-Reported Recovery In Patients With Neck Pain, Elizabeth Oakley, Chad E. Cook, Bryan O'Halloran

Faculty Publications

Background

The SANE is a PROM of recovery, which may assist clinicians in clinical decision-making and discharge planning. The psychometric measurement properties of the SANE have yet to be determined for neck pain.

Objectives

Threefold objectives included: 1)determine the numerical threshold for the SANE at which patients with neck pain determine their symptoms are acceptable; 2)determine the association between scores for the NDI and VAS, with the SANE; 3)determine the average number of visits, costs and value associated with the management of neck pain.

Design

Longitudinal repeated measures cohort design.

Methods

Threshold measures for self-reported recovery with the …

Self-Paced Treadmills Do Not Allow For Valid Observation Of Linear And Nonlinear Gait Variability Outcomes In Patients With Parkinson’S Disease, Maryam Rohafza, Rahul Soangra, Jo Armour Smith, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background

Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods

Thirteen patients with Parkinson’s Disease …

Investigating Professional Development: Comparing Students Self-Assessment With Assessment Of The Clinical Instructors, Johana Kontarovsky Spt, Jennifer Hastings Pt, Phd

Physical Therapy Research Symposium

Investigating Professional Development: Comparing Students Self-Assessment with Assessment of the Clinical Instructors

Johana Kontarovsky, SPT
Mentor: Jennifer Hastings PT, PhD

Background: Professional behavior and self-assessment are aspects that are paramount to being a successful medical professional.

Purpose: This purpose of this study was to look at the development of professionalism in the cohort of 2020 at our institution. The concept was to investigate the students’ use of reflection as a foundation for personal and professional development.

Methods: The Self Reflection and Insight Scale (SRIS) was given to the SPTs September and December 2017 as well as May of 2020. The …

The Relationship Of Catastrophization, Pain Intensity, And Heart Rate Variability In Acute Pain - A Pilot Study, Carolyn Barbee Spt, Elizabeth A. Waddell Spt, Karin Steere Dpt

Physical Therapy Research Symposium

Background: Reduction in heart rate variability (HRV) can strongly and independently predict adverse health outcomes.Chronic pain conditions are associated with reduced HRV, and HRV may be a biomarker for predicting chronic pain.

Purpose: While pain intensity and catastrophization are associated with chronic pain,the aim of this study is to investigate their relationship with HRV in individuals with acute pain.

Methods: Fourteen subjects from two facilities participated. Data from two participants was excluded. HRV was collected while seated as participants completed an iPad survey. Raw inter-beat interval (IBI) data was analyzed with Kubios software.

Results: Multiple regression analyses were …

Influences Of Balance Confidence, Fear Of Falling, And Fall History On Physical Activity Levels In Community-Dwelling Older Adults, Alison Yang Spt, Holly Roberts Pt, Phd

Physical Therapy Research Symposium

Background: Physical activity levels generally decline with increasing age. Few studies have examined the influences of balance confidence, fear of falling, and fall history on physical activity levels in older adults.

Purpose: To determine the relationships between balance confidence, fear of falling, fall history, and physical activity level in community-dwelling older adults.

Methods: Eighty-eight participants completed the Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), and a self-reported fall history. They reported their monthly activity levels using the Physical Activity Scale for the Elderly (PASE). Pearson correlation coefficients (r) were used to analyze …

Resiliency, Anxiety And Depression Amongst Dpt Students - A Survey During The Covid-19 Pandemic, Michaela Corbitt Spt, Amber Odo Spt, Robert Boyles Pt, Dsc, Ocs, Faaompt

Physical Therapy Research Symposium

Resiliency, Anxiety and Depression Amongst DPT Students–A Survey of Three Cohorts During the COVID-19 Pandemic

Michaela Corbitt, SPT; Amber Odo, SPT

Mentor: Robert Boyles, PT, DSc

Background: Doctor of Physical Therapy (DPT) programs are challenging due to the academic rigor, fast-paced learning environment, tuition cost, and feelings of inadequacy. Resiliency involves the ability to cope with stressors presented in daily life. Higher levels of resiliency has been associated with lower levels of depression, stress, and anxiety. This negative correlation may be key for preventing burnout, increasing life satisfaction, and prolonging careers for DPT graduates.

Purpose: To assess resiliency, anxiety and …

Treadmill Training For Infants With Down Syndrome: A Case Study, Mary Ngo Spt, Anna Paradee Spt, Julia Looper Pt, Phd

Physical Therapy Research Symposium

Background: Children with Down syndrome (DS) experience motor delays particularly with ambulation. Previous research has suggested that a 5 time per week, 8 minute per session protocol for treadmill training (TT) was effective in earlier acquisition of walking.

Purpose: To examine the effectiveness of a home-based 2 time per week, 20 minute per session TT protocol on the development of independent step taking in an infant with DS.

Methods: A 20-month-old boy with DS, underwent a repair for esophageal atresia at 5 months, and currently uses a feeding tube. He was independently sitting and non-ambulatory. Weekly Zoom meetings were conducted …

Association Of The Psychological Response To The Acl-Sports Training Program And Self-Reported Function At 2 Years After Anterior Cruciate Ligament Reconstruction, Ryan Zarzycki, Jacob J. Capin, Elanna Arhos, Matthew Failla, Angel H. Smith, Lynn Snyder-Mackler

Physical Therapy Faculty Research and Publications

Background:

Psychological readiness to return to sport has emerged as an important factor associated with outcomes after anterior cruciate ligament reconstruction (ACLR). Psychological factors are potentially modifiable during the course of rehabilitation, and improving them may lead to better outcomes.

Purpose:

To determine whether athletes with a positive psychological response after participation in a neuromuscular training and second injury prevention program had better self-reported function and activity outcomes compared with athletes who did not have a meaningful change.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

After ACLR and the completion of formal rehabilitation, 66 level I/II athletes completed …

Co-Contraction Of Ankle Muscle Activity During Quiet Standing In Individuals With Incomplete Spinal Cord Injury Is Associated With Postural Instability, Kai Lon Fok, Jae W Lee, Janelle Unger, Katherine Chan, Kristin E Musselman, Kei Masani

Physical Therapy Publications

Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), …

Functional Reach Test, Single-Leg Stance Test, And Tinetti Performance-Oriented Mobility Assessment For The Prediction Of Falls In Older Adults: A Systematic Review, Humberto Omaña, Kari Bezaire, Kyla Brady, Jayme Davies, Nancy Louwagie, Sean Power, Sydney Santin, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations.

METHODS: The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale.

RESULTS: Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 …

Reporting Of Harm In Randomized Controlled Trials Of Therapeutic Exercise For Knee Osteoarthritis: A Systematic Review, Johan Von Heideken, Sana Chowdhry, Joanna Borg, Khara James, Maura D. Iversen

Physical Therapy Faculty Publications

Objective: The Consolidated Standards of Reporting Trials (CONSORT) recommends reporting adverse events (AEs) and dropouts (DOs) with their definitions. The purpose of this study was to identify how AEs and DOs were reported in randomized controlled trials (RCTs) of therapeutic exercise for knee osteoarthritis (OA).

Methods: Data sources were the Cochrane Library, EMBASE, PUBMED, and CINAHL. Databases were searched to identify RCTs of therapeutic exercise for Knee OA published from January 1, 1980, through July 23, 2020. Researchers independently extracted participant and intervention characteristics and determined whether a clear statement of and reasons for AEs and DOs existed. The primary …

Disability And Healthcare Access In Morocco: Social And Cultural Influences, Christa Shipman

Independent Study Project (ISP) Collection

I stepped into the SIT Multiculturalism and Human Rights program as a pre-physical therapy student with experience working and volunteering in the disability rights arena. Striking personal encounters with Moroccans combined with these past experiences drew me to investigate how social and cultural factors influence access to healthcare for people with disabilities. I hypothesized that access to medical care is limited by social or cultural mindsets, perceptions, or beliefs for those in my target population. This subject is relevant to Morocco as a developing country and as a society with, in some cases, fixed social dynamics, while in other areas …

Providing Occupational And Physical Therapy Services In A Free Community-Based Interprofessional Primary Care Clinic, David Chapman, Darla Coss, John Fleming

Physical Therapy Faculty Scholarship

Interprofessional care provided in a free community-based clinic that focuses on chronic health conditions and health promotion provides an innovative solution to improve societal health. Many existing clinics provide a range of professions but few include allied health services such as occupational and physical therapy. This paper provides a description of the development and implementation of an expanded faculty-guided student-led community based primary care clinic that includes occupational and physical therapists as part of an interprofessional collaborative practice model. A detailed description and explanation of the partners involved, the institutional missions that drive this work, the logistics completed that enabled …

Prevalence Of Soccer Heading In Middle School American Youth Club Soccer Players, Pedro Gonzalez-Cabrera, Mohan Ganesan, Julie Jameson, Deanna M. Hughes

Physical Therapy Collection

The purpose of this study was to evaluate the prevalence of soccer heading during a season in a youth soccer club competitive team

Heading events were recorded real time using a recording datasheet for a single team and their opponent teams during the 2014 season of a youth soccer league. Position on the field at the time of the heading event was also documented.

Mean heading events were 35.5 events/match. A paired sample t-test showed no statistically significant difference between observed team and opponent teams. Mean standardized assessment of concussion (SAC) score for the observed soccer team was 24.9±2.6 (out …

Mobile Phone Sensors Can Discern Medication-Related Gait Quality Changes In Parkinson's Patients In The Home Environment, Albert Pierce, Niklas König Ignasiak, Wilford K. Eiteman-Pang, Cyril Rakovski, Vincent Berardi

Psychology Faculty Articles and Research

Patients with Parkinson's Disease (PD) experience daytime symptom fluctuations, which result in small amplitude, slow and unstable walking during times when medication attenuates. The ability to identify dysfunctional gait patterns throughout the day from raw mobile phone acceleration and gyroscope signals would allow the development of applications to provide real-time interventions to facilitate walking performance by, for example, providing external rhythmic cues. Patients (n = 20, mean Hoehn and Yahr: 2.25) had their ambulatory data recorded and were directly observed twice during one day: once after medication abstention, (OFF) and once approximately 30 min after intake of their medication …

Front-Loading Of Anatomy Content Has No Effect On Long-Term Anatomy Knowledge Retention Among Physical Therapy Students: A Prospective Cohort Study., Amy H. Amabile, Kim Nixon-Cave, Larry J. Georgetti, Ashley C. Sims

Department of Physical Therapy Faculty Papers

BACKGROUND: Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. The research hypothesis was that students receiving spaced instruction would have significantly better anatomy …

The Effect Of First-Time 4-Wheeled Walker Use On The Gait Of Younger And Older Adults, Humberto A. Omana, Edward Madou, Alison Divine, Walter Wittich, Keith D. Hill, Andrew M. Johnson, Jeffrey D. Holmes, Susan W. Hunter

Physical Therapy Publications

INTRODUCTION: The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required.

OBJECTIVE: To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults.

DESIGN: Cross-sectional, repeated-measures.

SETTING: Community-dwelling.

PARTICIPANTS: Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people …

Effects Of Rucksack Military Accessory On Gait Dynamic Stability, Seong H. Moon, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Various factors are responsible for injuries that occur in the U.S. Army soldiers. In particular, rucksack load carriage equipment influences the stability of the lower extremities and possibly affects gait balance. The objective of this investigation was to assess the gait and local dynamic stability of the lower extremity of five subjects as they performed a simulated rucksack march on a treadmill. The Motek Gait Real-time Interactive Laboratory (GRAIL) was utilized to replicate the environment of the rucksack march. The first walking trial was without a rucksack and the second set was executed with the All-Purpose Lightweight Individual Carrying Equipment …