Medicine and Health Sciences Commons^™

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

What’S All The Racket? Comparing Physical Health Outcomes Between Pickleball And Tennis In Older Athletes, Megan Doneen Wilson Spt, Ashley Nicole Meldrum Spt, Austin Jeffrey Buchholz Spt, Andrew David Taverna Spt, Michael John Olson Spt

Physical Therapy Student Research Projects

Background: Pickleball is rising in popularity, especially among older adults. Pickleball boasts psychological and physical benefits to aging athletes. Singles pickleball has been found to approximate brisk walking in metabolic equivalents (METs) at 4.1, while the METs level for singles tennis is 7.0-8.0. The physical health benefits of tennis are known to be positive while those of pickleball are still being explored. With objective differences in MET level it may be surmised that health outcomes might vary between the two sports.

Purpose: The purpose of this study was to use the Senior Athlete Fitness Exam (SAFE) to quantify and compare …

Degenerative Cervical Myelopathy Delays Responses To Lateral Balance Perturbations Regardless Of Predictability, T. F. Boerger, L. Mcginn, M. C. Wang, Brian Schmit, Allison S. Hyngstrom

Physical Therapy Faculty Research and Publications

The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R2 = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

The Effect Of Perturbation-Based Balance Training And Conventional Intensive Balance Training On Reactive Stepping Ability In Individuals With Incomplete Spinal Cord Injury Or Disease: A Randomized Clinical Trial, Janelle Unger, Katherine Chan, Jae W Lee, B Catharine Craven, Avril Mansfield, Mohammad Alavinia, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.

Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.

Design: Randomized clinical trial.

Setting: Tertiary SCI/D rehabilitation center.

Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.

Methods: Participants were randomly allocated …

A Consensus Guide To Using Functional Near-Infrared Spectroscopy In Posture And Gait Research, Jasmine C. Menant, Inbal Maidan, Lisa Alcock, Emad Al-Yahya, Antonio Cerasa, David J. Clark, Eling D. De Bruin, Sarah Fraser, Vera Gramigna, Dennis Hamacher, Fabian Herold, Roee Holtzer, Meltem Izzetoglu, Shannon Lim, Annette Pantall, Paulo Pelicioni, Sue Peters, Andrea L. Rosso, Rebecca St George, Samuel Stuart, Roberta Vasta, Rodrigo Vitorio, Anat Mirelman

Physical Therapy Publications

Background: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works.

Research question and methods: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders.

Results: Our paper is organized around three main sections: …

Mediolateral Damping Of An Overhead Body Weight Support System Assists Stability During Treadmill Walking, M. Bannwart, S. L. Bayer, Niklas König Ignasiak, M. Bolliger, G. Rauter, C. A. Easthope

Physical Therapy Faculty Articles and Research

Background

Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along …

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Developmental Trajectories For The Early Clinical Assessment Of Balance By Gross Motor Function Classification System Level For Children With Cerebral Palsy., Alyssa Laforme Fiss, Sarah Westcott Mccoy, Doreen Bartlett, Lisa Avery, Steven E Hanna, On Track Study Team

Physical Therapy Publications

Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels.

Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels.

Design: The design was a longitudinal cohort study.

Methods: Participants included 708 children with …

Preseason Y Balance Test Scores Are Not Associated With Noncontact Time-Loss Lower Quadrant Injury In Male Collegiate Basketball Players, Jason Brumitt, Kyle Nelson, Duane Duey, Matthew Jeppson, Luke Hammer

Faculty Publications - College of Physical Therapy

The Y-Balance Test-Lower Quarter has shown promise as a screening tool for identifying athletes at risk of injury. Subsequent studies, utilizing heterogeneous populations or different operational definitions of injury, have presented equivocal findings. Therefore, studies evaluating the efficacy of the Y-Balance Test to discriminate injury risk in a homogeneous population is warranted. One-hundred sixty-nine male (mean age 19.9 + 1.5 y) collegiate basketball players were recruited during 2 consecutive seasons (2016–2017/2017–2018). Athletes completed the Y-Balance testing protocol at the start of each preseason. Athletic trainers tracked noncontact time-loss lower quadrant injuries over the course of the season. Receiver operator characteristic …

Head-Shake Sensory Organization Test Performance In Concussed Military Service Members., Brandon Roadman, Daniel Trapp, Dr. Holly Roberts Pt, Dpt, Gcs, Ncs

Physical Therapy Research Symposium

Title: Head-Shake Sensory Organization Test Performance in Concussed Military Service Members.

Purpose: The purpose of the study was to describe performance on the Sensory Organization Test (SOT) and Head-Shake SOT (HS-SOT) in military service members with concussions.

Subjects: Seventeen military service members (16 men, mean 32.47 +/-8.01 years) who sustained a concussion within the past 24 months.

Methods: Participants completed the SOT and HS-SOT, Activities-specific Balance Confidence scale (ABC), and Dizziness Handicap Inventory (DHI). Separate analyses were performed with subjects divided into groups based on concussion history(>3), and DHI score (>13).

Results: Participants had a mean DHI score …

Preseason Y Balance Test Scores Are Not Associated With Noncontact Time-Loss Lower Quadrant Injury In Male Collegiate Basketball Players, Jason Brumitt, Kyle Nelson, Duane Duey, Matthew Jeppson, Luke Hammer

Faculty Publications - College of Physical Therapy

The Y-Balance Test-Lower Quarter has shown promise as a screening tool for identifying athletes at risk of injury. Subsequent studies, utilizing heterogeneous populations or different operational definitions of injury, have presented equivocal findings. Therefore, studies evaluating the efficacy of the Y-Balance Test to discriminate injury risk in a homogeneous population is warranted. One-hundred sixty-nine male (mean age 19.9 + 1.5 y) collegiate basketball players were recruited during 2 consecutive seasons (2016–2017/2017–2018). Athletes completed the Y-Balance testing protocol at the start of each preseason. Athletic trainers tracked noncontact time-loss lower quadrant injuries over the course of the season. Receiver operator characteristic …

Effect Of Whole-Body Vibration On Center-Of-Mass Movement During Standing In Children And Young Adults, Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5min after 40-s WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5min after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.

The Nature Of Movement Symmetry: Implications For Function And Injury Risk, Laura Broudy, Spt, Aerie Glowka, Spt, Katie Schaner, Spt, Michelle Wrigley, Spt, Danny Mcmillian, Dsc, Mpt, Cscs

Physical Therapy Research Symposium

Human movement requires an equipoise of mobility, strength, and neuromuscular control for optimal performance and injury protection. When certain movement asymmetries are present they create functional impairments that can negatively impact an individual’s performance and increase the likelihood for injury. This results in decreased quality of life due to missed time from work, sport, or social interaction and increased financial burden. There is limited evidence addressing what degree of asymmetry impacts functional performance or increases injury risk. Some activities such as throwing are naturally asymmetrical, thus asymmetry of the upper extremity may be beneficial in specific occupations or sporting professions. …

Influence Of Visual Feedback On Dynamic Balance Control In Chronic Stroke Survivors, Eric R. Walker, Allison S. Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Chronic stroke survivors have an increased incidence of falls during walking, suggesting changes in dynamic balance control post-stroke. Despite this increased incidence of falls during walking, balance control is often studied only in standing. The purpose of this study was to quantify deficits in dynamic balance control during walking, and to evaluate the influence of visual feedback on this control in stroke survivors. Ten individuals with chronic stroke, and ten neurologically intact individuals participated in this study. Walking performance was assessed while participants walked on an instrumented split-belt treadmill with different types of visual feedback. Dynamic balance control was quantified …

Balance-Related Outcome Measures Of Acquired Brain Injury Patients In A Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review, Lauren M. Wilson, Corey R. Kaleshnik, Parke K. Humphrey, Ann M. Wilson

Physical Therapy Research Symposium

Title: Balance-Related Outcome Measures of Acquired Brain Injury Patients in a Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review

Authors: Parke Humphrey, SPT; Corey Kaleshnik, SPT; Lauren Wilson, SPT; Ann Wilson, PT, MEd, GCS

Affiliation(s): 1. Physical Therapy Program, University of Puget Sound

Purpose: Individuals with Acquired Brain Injury (ABI) often have balance impairments. Interventions targeting these impairments may improve balance and thus increase overall societal participation. The purpose of this review was to identify the types of balance-related outcome measures used to assess balance impairments in patients with ABI in a student-led onsite physical therapy clinic.

Subjects: 13 …

Identification Of Functional Parameters For The Classification Of Older Female Fallers And Prediction Of ‘First-Time’ Fallers, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60–85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a …

Sensory Electrical Stimulation Improves Foot Placement During Targeted Stepping Post-Stroke, Eric R. Walker, Allison Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Proper foot placement is vital for maintaining balance during walking, requiring the integration of multiple sensory signals with motor commands. Disruption of brain structures post-stroke likely alters the processing of sensory information by motor centers, interfering with precision control of foot placement and walking function for stroke survivors. In this study, we examined whether somatosensory stimulation, which improves functional movements of the paretic hand, could be used to improve foot placement of the paretic limb. Foot placement was evaluated before, during, and after application of somatosensory electrical stimulation to the paretic foot during a targeted stepping task. Starting from standing, …

Use Of Item Response Analysis To Investigate Measurement Properties And Clinical Validity Of Data For The Dynamic Gait Index, Yi-Po Chiu, Stacy L. Fritz, Kathye E. Light, Craig A. Velozo

Physical Therapy Faculty Research

Background and Purpose. The Dynamic Gait Index (DGI) is a standardized clinical assessment that aids in evaluating a subject’s ability to modify gait in response to changing demands. The purpose of this study was to use Rasch measurement theory to examine whether the DGI rating scale meets suggested psychometric guidelines, whether the hierarchical order of DGI tasks is consistent with a clinically logical testing procedure, and whether the DGI represents a unidimensional construct. Subjects. Subjects were 84 community-dwelling male veterans (age range=64–88 years; mean±SD=75±6.47 years). Methods. Data were retrieved retrospectively from the participants’ clinical records. The Rasch measurement model with …

A Comparison Of Hip Versus Ankle Exercises In Elders And The Influence On Balance And Gait, Laura Z. Gras, Pamela Levangie, Mary (Tina) Goodwin-Segal, Deborah A. Lawrence

All PTHMS Faculty Publications

Purpose: Reductions in hip and ankle strength and range of motion (ROM) in elderly subjects have been associated with decreased functional mobility and risk of falls. The purpose of this research was to determine if short duration hip or ankle interventions designed to increase ROM and strength could improve ROM and strength of those joints, as well as improve balance and gait outcomes. Methods: Well elderly volunteers recruited from retirement communities and a senior citizen center were randomly assigned to a hip or ankle intervention group. Both groups performed a home exercise program (HEP) of stretching 5 days a week …

Whole Body Momentum During Gait: A Preliminary Study Of Non-Fallers And Frequent Fallers, Guy G. Simoneau, David E. Krebs

Physical Therapy Faculty Research and Publications

The importance of momentum in compensating for elderly individua ls ' strength deficits to achieve activities of daily living. such as rising from a chair ha.!o been demonstrated in earlier studies. Here we present a case control study of three healthy "non-fallers" and two "frequent fallers," All 5 elders were community-living and were tested in the gai l laboratory. A four-camera Selspot system was used to obtain whole-body momentum from an 11-segment kinematic model. Ground reaction forces and kinematics were used 10 calculate lower extremity join! moments. With the exception of the whole-body's angular momentum about the vertical axis, linear …