Medicine and Health Sciences Commons^™

Bone–Patellar Tendon–Bone Autograft Harvest Prolongs Extensor Latency During Gait 2 Yr After Aclr, Naoaki Ito, Jacob J. Capin, Ashutosh Khandha, Thomas S. Buchanan, Karin Grävare Silbernagel, Lynn Snyder-Mackler

Physical Therapy Faculty Research and Publications

Purpose

Bone–patellar tendon–bone (BPTB) graft harvest for anterior cruciate ligament reconstruction alters patellar tendon properties, which inflict poor quadriceps neuromuscular function. BPTB autografts are associated with higher rates of posttraumatic osteoarthritis, which in turn is associated with pathological gait. The purpose of this study was to investigate the latency between the time of peak quadriceps activity and the peak knee flexion moment during gait, between those with BPTB grafts (n = 23) and other graft types (hamstring autograft or allografts, n = 54), 5 ± 2 months and 2 yr (25 ± 3 months) after anterior cruciate ligament reconstruction. …

Single Muscle Fibre Contractile Function With Ageing, Gregory J. Grosicki, Carlos S. Zepeda, Christopher W. Sundberg

Physical Therapy Faculty Research and Publications

Ageing is accompanied by decrements in the size and function of skeletal muscle that compromise independence and quality of life in older adults. Developing therapeutic strategies to ameliorate these changes is critical but requires an in-depth mechanistic understanding of the underlying physiology. Over the past 25 years, studies on the contractile mechanics of isolated human muscle fibres have been instrumental in facilitating our understanding of the cellular mechanisms contributing to age-related skeletal muscle dysfunction. The purpose of this review is to characterize the changes that occur in single muscle fibre size and contractile function with ageing and identify key areas …

Knee Joint Biomechanics During Gait Improve From 3 To 6 Months After Anterior Cruciate Ligament Reconstruction, Kelsey Neal, Jack R. Williams, Abdulmajeed Alfayyadh, Jacob J. Capin, Ashutosh Khandha, Kurt Manal, Lynn Snyder-Mackler, Thomas S. Buchanan

Physical Therapy Faculty Research and Publications

Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two …

Role Of Physical Therapists In The Management Of Individuals At Risk For Or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022, Ellen Hillegass, Kathleen M. Lukaszewicz, Michael Puthoff

Physical Therapy Faculty Research and Publications

No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association’s Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key …

Cost-Effectiveness Of High-Intensity Training Vs Conventional Therapy For Individuals With Subacute Stroke, T. George Hornby, Miriam Rafferty, Daniel Pinto, Dustin D. French, Neil Jordan

Physical Therapy Faculty Research and Publications

Objective

This investigation estimated the incremental cost-effectiveness of high-intensity training (HIT) compared with conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy.

Design

Secondary analysis from a pilot study and subsequent randomized controlled trial.

Setting

Outpatient laboratory setting.

Participants

Data were collected from individuals with locomotor impairments 1-6 months poststroke (N=44) who participated in HIT (n=27) or conventional physical therapy (n=17).

Interventions

Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional …

Identifying Gait Pathology After Acl Reconstruction Using Temporal Characteristics Of Kinetics And Electromyography, Naoaki Ito, Jacob J. Capin, Ashutosh Khandha, Thomas S. Buchanan, Lynn Snyder-Mackler

Physical Therapy Faculty Research and Publications

Purpose

Asymmetrical gait mechanics after anterior cruciate ligament reconstruction (ACLR) are associated with the development of posttraumatic knee osteoarthritis. Current measures of gait mechanics have focused heavily on peak magnitudes of knee kinematics, kinetics, and joint contact forces but have seldom considered the rate of knee loading, cumulative knee load, or the timing of motor input surrounding peaks. The purpose of this study was to introduce and describe novel metrics of gait using temporal characteristics of kinetics and EMG to identify neuromuscular deficits of the quadriceps in patients after ACLR.

Methods

Gait mechanics were assessed 6 months (n = …

Total Knee Arthroplasty Assessments Should Include Strength And Performance-Based Functional Tests To Complement Range-Of-Motion And Patient-Reported Outcome Measures, Jacob J. Capin, Michael J. Bade, Jason M. Jennings, Lynn Snyder-Mackler, Jennifer E. Stevens-Lapsley

Physical Therapy Faculty Research and Publications

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to …

Symmetry Is Associated With Interlimb Coordination During Walking And Pedaling After Stroke, Brice T. Cleland, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

Background and Purpose:

Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.

Methods:

Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsion_walk, %Work_ped) and interlimb phase coordination index (PCI_walk, PCI_ped) were …

Predicting Duration Of Outpatient Physical Therapy Episodes For Individuals With Spinal Cord Injury Based On Locomotor Training Strategy, Mauricio Garnier-Villarreal, Daniel Pinto, Chaithanya K. Mummidisetty, Arun Jayaraman, Candy Tefertiller, Susan Charlifue, Heather B. Tayler, Shuo-Hsiu Chang, Nicholas Mccombs, Catherine L. Furbish, Edelle C. Field-Fote, Allen W. Heinemann

Physical Therapy Faculty Research and Publications

Objective

To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy.

Design

Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services.

Setting

Rehabilitation and community wellness facilities at 4 SCI Model Systems centers.

Participants

Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of …

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.

Prospective Telehealth Analysis Of Functional Performance, Frailty, Quality Of Life, And Mental Health After Covid-19 Hospitalization, Jacob J. Capin, Melissa P. Wilson, Kristine Hare, Swati Vempati, Carley E. Little, Donna Mcgregor, Jose Castillo-Mancilla, Jennifer E. Stevens-Lapsley, Sarah Jolley, Kristine M. Erlandson

Physical Therapy Faculty Research and Publications

Background

COVID-19 is a global pandemic with poorly understood long-term consequences. Determining the trajectory of recovery following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation. The purpose of this study was to prospectively evaluate recovery following COVID-19 hospitalization.

Methods

Participants age 18 years or older who were hospitalized for ≥24 h due to COVID-19 completed phone/video call virtual assessments (including the 10-time chair rise test) and survey forms at three time points (2–6, 12, and 18 weeks) after hospital discharge. Univariate logistic and linear regression models assessed the associations of the outcomes with primary …

Task Effects On Functional Connectivity Measures After Stroke, Kaleb Vinehout, Sheila M. Schindler-Ivens, Jeffrey R. Binder, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Understanding the effect of task compared to rest on detecting stroke-related network abnormalities will inform efforts to optimize detection of such abnormalities. The goal of this work was to determine whether connectivity measures obtained during an overt task are more effective than connectivity obtained during a “resting” state for detecting stroke-related changes in network function of the brain. This study examined working memory, discrete pedaling, continuous pedaling and language tasks. Functional magnetic resonance imaging was used to examine regional and inter-regional brain network function in 14 stroke and 16 control participants. Independent component analysis was used to identify 149 regions …

Disparities In The Allocation Of Inpatient Physical And Occupational Therapy Services For Patients With Covid-19, Sarah Jolley, Amy Nordon-Craft, Melissa P. Wilson, Kyle Ridgeway, Michelle R. Rauzi, Jacob J. Capin, Lauren M. Heery, Jennifer Stevens-Lapsley, Kristine M. Erlandson

Physical Therapy Faculty Research and Publications

Background

Survivors of the novel coronavirus (COVID-19) experience significant morbidity with reduced physical function and impairments in activities of daily living. The use of in-hospital rehabilitation therapy may reduce long-term impairments.

Objective

To determine the frequency of therapy referral and treatment amongst hospitalized COVID-19 patients, assess for disparities in referral and receipt of therapy, and identify potentially modifiable factors contributing to disparities in therapy allocation.

Design, Setting and Participants

Retrospective cohort study using data collected from the University of Colorado Health Data Compass data warehouse assessing therapy referral rates and estimated delivery based on available administrative billing.

Measurements

Multivariable logistic …

Developing Peri-Operative Rehabilitation In Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 6]: An Unexplored Opportunity?, Timothy F. Boerger, Allison S. Hyngstrom, Julio C. Furlan, Sukhvinder Klasi-Ryan, Armin Curt, Brian K. Kwon, Shekar N. Kurpad, Michael G. Fehlings, James S. Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D. Guest, Jefferson R. Wilson, Benjamin M. Davies, Mark R. N. Kotter, Paul A. Koljonen

Physical Therapy Faculty Research and Publications

Study Design

Narrative review.

Objective

Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.

Methods

Literature search.

Results

In other neurological disorders such as …

Laterality Of The Activation Of The Vastus Lateralis Muscle In Females With Parkinson's Disease During The Medication State Compared With Healthy Controls, Yuichi Nishikawa, Kohei Watanabe, Tetsuya Takahashi, Noriaki Maeda, Hirofumi Maruyama, Shinobu Tanaka, Allison S. Hyngstrom

Physical Therapy Faculty Research and Publications

This study quantified the laterality of motor unit activation properties in females with Parkinson’s disease during force production (low to high-intensity contraction) using high-density surface electromyography. Sixteen females with Parkinson’s disease (age = ± 7.6 years, disease duration = 4.9 ± 5.1 years) and 14 healthy female subjects (age = 68.6 ± 3.6 years) performed submaximal ramp-up contractions during isometric knee extension. High-density surface electromyography signals were recorded from both vastus lateralis muscles. The level of heterogeneity was calculated in the spatial distribution patterns of the high-density surface electromyography signals to determine the modified entropy, coefficient of variation of the …

Knee Cartilage T2 Relaxation Times 3 Months After Acl Reconstruction Are Associated With Knee Gait Variables Linked To Knee Osteoarthritis, Jack R. Williams, Kelsey Neal, Abdulmajeed Alfayyadh, Kendra Lennon, Jacob J. Capin, Ashutosh Khandha, Kurt Manal, Hollis G. Potter, Lynn Snyder-Mackler, Thomas S. Buchanan

Physical Therapy Faculty Research and Publications

Osteoarthritis development after ACL reconstruction (ACLR) is not well understood. Investigators have examined associations between knee biomechanical alterations and quantitative MRI (qMRI) variables, reflective of cartilage health, 12–60 months following ACLR; however, none have done so early after surgery. As part of an exploratory study, 45 individuals (age, 23 ± 7 years) underwent motion analysis during walking and qMRI 3 months after ACLR. For each limb, peak knee adduction moment (pKAM) and peak knee flexion moment (pKFM) were determined using inverse dynamics and peak medial compartment force was calculated using a neuromusculoskeletal model. T₂ relaxation times in the medial …

Development Of A National Pain Management Competency Profile To Guide Entry-Level Physiotherapy Education In Canada, Nathan Augeard, Geoff Bostick, Jordan Miller, David Walton, Yannick Tousignant-Laflamme, Anne Hudon, André Bussières, Lynn Cooper, Nicol Mcniven, Aliki Thomas, Lesley Singer, Scott M. Fishman, Marie K. Hoeger Bement, Julia M. Hush, Kathleen A. Sluka, Judy Watt-Watson, Lisa C. Carlesso, Sinead Dufour, Roland Fletcher, Katherine Harman, Judith Hunter, Suzy Ngomo, Neil Pearson, Kadija Perreault, Barbara Shay, Peter Stilwell, Susan Tupper, Timothy H. Wideman

Physical Therapy Faculty Research and Publications

Background

National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across …

Safety, Feasibility And Initial Efficacy Of An App-Facilitated Telerehabilitation (After) Programme For Covid-19 Survivors: A Pilot Randomised Study, Jacob J. Capin, Sarah Jolley, Mary Morrow, Meghan Connors, Kristine Hare, Samantha Mawhinney, Amy Nordon-Craft, Michelle R. Rauzi, Sheryl Flynn, Jennifer Stevens-Lapsley, Kristine M. Erlandson

Physical Therapy Faculty Research and Publications

Objectives Determine the safety, feasibility and initial efficacy of a multicomponent telerehabilitation programme for COVID-19 survivors.

Design Pilot randomised feasibility study.

Setting In-home telerehabilitation.

Participants 44 participants (21 female, mean age 52 years) discharged home following hospitalisation with COVID-19 (with and without intensive care unit (ICU) stay).

Interventions Participants were block randomised 2:1 to receive 12 individual biobehaviourally informed, app-facilitated, multicomponent telerehabilitation sessions with a licenced physical therapist (n=29) or to a control group (n=15) consisting of education on exercise and COVID-19 recovery trajectory, physical activity and vitals monitoring, and weekly check-ins with study staff. Interventions were 100% remote and …