Medicine and Health Sciences Commons^™

Elastic Resistance Effectiveness On Increasing Strength Of Shoulders And Hips, Kelsey J. Picha, Muataz R. Almaddah, Jordan Barker, Tavis Ciochetty, W. Scott Black, Timothy L. Uhl

Physical Therapy Faculty Publications

Elastic resistance is a common training method used to gain strength. Currently, progression with elastic resistance is based on the perceived exertion of the exercise or completion of targeted repetitions; exact resistance is typically unknown. This study's objective is to determine if knowledge of load during elastic resistance exercise will increase strength gains during exercises. Participants were randomized into two strength training groups, elastic resistance only and elastic resistance using a load cell (LC) that displays force during exercise. The LC group used a Smart Handle (Patterson Medical Supply, Chicago, IL) to complete all exercises. Each participant completed the same …

The Relationship Between Pitching Volume And Arm Soreness In Collegiate Baseball Pitchers, Angel L. Lazu, Shawn D. Love, Timothy A. Butterfield, Robert A. English, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: Excessive baseball pitch volume has been associated with increased risk of injury in adolescents. However, many collegiate athletes report non-time loss injuries over the course of the season. It is unknown how pitch volume throughout a collegiate baseball season affects arm soreness.

Purpose: The primary purpose of this study was to determine the relationship between pitch volume and self-reported arm soreness. A secondary purpose was to determine the relationship between change in pitch volume and change in arm soreness over the course of the season for collegiate baseball pitchers.

Study Design: Prospective Cohort.

Methods: Seven collegiate baseball …

Neuromuscular Adaptions Following A Daily Strengthening Exercise In Individuals With Rotator Cuff Related Shoulder Pain: A Pilot Case-Control Study, Amee L. Seitz, Lisa A. Podlecki, Emily R. Melton, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: The goal of therapeutic exercise is to facilitate a neuromuscular response by increasing or decreasing muscular activity in order to reduce pain and improve function. It is not clear what dosage of exercise will create a neuromuscular response.

Purpose: The purpose of this study was to assess the effects following a three-week home program of a daily single exercise, the prone horizontal abduction exercise (PHA), on neuromuscular impairments of motor control as measured by scapular muscle EMG amplitudes, strength, and secondarily outcomes of self-reported pain and function between individuals with and without subacromial pain syndrome.

Study Design: Prospective Case-Control, …

Acute Treadmill Exercise Discriminately Improves The Skeletal Muscle Insulin-Stimulated Growth Signaling Responses In Mice Lacking Redd1, Cory M. Dungan, Bradley S. Gordon, David L Williamson

Physical Therapy Faculty Publications

A loss of the regulated in development and DNA damage 1 (REDD1) hyperactivates mechanistic Target of Rapamycin Complex 1 (mTORC1) reducing insulin‐stimulated insulin signaling, which could provide insight into mechanisms of insulin resistance. Although aerobic exercise acutely inhibits mTORC1 signaling, improvements in insulin‐stimulated signaling are exhibited. The goal of this study was to determine if a single bout of treadmill exercise was sufficient to improve insulin signaling in mice lacking REDD1. REDD1 wildtype (WT) and REDD1 knockout (KO) mice were acutely exercised on a treadmill (30 min, 20 m/min, 5% grade). A within animal noninsulin‐to‐insulin‐stimulated percent change in skeletal muscle …

Identification Of Knee Gait Waveform Pattern Alterations In Individuals With Patellofemoral Pain Using Fast Fourier Transform, Kristin D. Morgan, Brian W. Noehren

Physical Therapy Faculty Publications

Patellofemoral pain (PFP) is one of the most common overuse injuries of the knee. Previous research has found that individuals with PFP exhibit differences in peak hip kinematics; however, differences in peak knee kinematics, where the pain originates, are difficult to elucidate. To better understand the mechanism behind PFP, we sought to characterize differences in knee gait kinematic waveform patterns in individuals with PFP compared to healthy individuals using fast Fourier transform (FFT). Sixteen control and sixteen individuals with PFP participated in a fast walk protocol. FFT was used to decompose the sagittal, frontal and transverse plane knee gait waveforms …

Enriched Physical Environment Attenuates Spatial And Social Memory Impairments Of Aged Socially Isolated Mice, Linmei Wang, Min Cao, Tinglin Pu, Huang Huang, Charles Marshall, Ming Xiao

Physical Therapy Faculty Publications

Background: Social isolation in the elderly is one of the principal health risks in an aging society. Physical environmental enrichment is shown to improve sensory, cognitive, and motor functions, but it is unknown whether environmental enrichment can protect against brain impairments caused by social isolation.

Methods: Eighteen-month-old mice were housed, either grouped or isolated, in a standard or enriched environment for 2 months, respectively. Behavioral tests were performed to evaluate cognitive functional and social interaction ability. Synaptic protein levels, myelination, neuroinflammation, brain derived neurotrophic factor, and NOD-like receptor protein 3 inflammasome signaling pathways were examined in the medial prefrontal cortex …

An Electromyography Study Of Muscular Endurance During The Posterior Shoulder Endurance Test, Neil A. Evans, Emily Dressler, Timothy L. Uhl

Physical Therapy Faculty Publications

The primary purpose was to determine if there is a difference between the median frequency slopes of 5 posterior shoulder muscles during the initial portion of the Posterior Shoulder Endurance Test (PSET) at the 90° and 135° shoulder abduction positions. Fifty-five healthy volunteers (31 females) participated. The median frequency of the posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and infraspinatus (INF) was measured during the PSET at 90° and 135° of shoulder abduction. External torque of 13 ± 1 Nm was used for females and 21 ± 1 Nm for males. A fixed effect multi-variable …

Immunohistochemical Identification Of Human Skeletal Muscle Macrophages, Kate Kosmac, Bailey D. Peck, R. Grace Walton, Jyothi Mula, Philip A. Kern, Marcas M. Bamman, Richard A. Dennis, Cale A. Jacobs, Christian Lattermann, Darren L. Johnson, Charlotte A. Peterson

Physical Therapy Faculty Publications

Macrophages have well-characterized roles in skeletal muscle repair and regeneration. Relatively little is known regarding the role of resident macrophages in skeletal muscle homeostasis, extracellular matrix remodeling, growth, metabolism and adaptation to various stimuli including exercise and training. Despite speculation into macrophage contributions during these processes, studies characterizing macrophages in non-injured muscle are limited and methods used to identify macrophages vary. A standardized method for the identification of human resident skeletal muscle macrophages will aide in the characterization of these immune cells and allow for the comparison of results across studies. Here, we present an immunohistochemistry (IHC) protocol, validated by …

Morphoregulatory Functions Of The Rna-Binding Motif Protein 3 In Cell Spreading, Polarity And Migration, J. Pilotte, W. Kiosses, S. W. Chan, H. P. Makarenkova, Esther E. Dupont-Versteegden, P. W. Vanderklish

Physical Therapy Faculty Publications

RNA-binding proteins are emerging as key regulators of transitions in cell morphology. The RNA-binding motif protein 3 (RBM3) is a cold-inducible RNA-binding protein with broadly relevant roles in cellular protection, and putative functions in cancer and development. Several findings suggest that RBM3 has morphoregulatory functions germane to its roles in these contexts. For example, RBM3 helps maintain the morphological integrity of cell protrusions during cell stress and disease. Moreover, it is highly expressed in migrating neurons of the developing brain and in cancer invadopodia, suggesting roles in migration. We here show that RBM3 regulates cell polarity, spreading and migration. RBM3 …

National Athletic Trainers' Association Position Statement: Evaluation, Management, And Outcomes Of And Return-To-Play Criteria For Overhead Athletes With Superior Labral Anterior-Posterior Injuries, Lori A. Michener, Jeffrey S. Abrams, Kellie C. Huxel Bliven, Sue Falsone, Kevin G. Laudner, Edward G. Mcfarland, James E. Tibone, Charles A. Thigpen, Timothy L. Uhl

Physical Therapy Faculty Publications

Objective: To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries.

Background: In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries.

Recommendations: Physical examination tests may aid diagnosis; 6 tests are recommended …

Calculation Of Resistive Loads For Elastic Resistive Exercises, Kelsey J. Picha, Timothy L. Uhl

Physical Therapy Faculty Publications

Context:

What is the correct resistive load to start resistive training with elastic resistance to gain strength? This question is typically answered by the clinician's best estimate and patient's level of discomfort without objective evidence.

Objective:

To determine the average level of resistance to initiate a strengthening routine with elastic resistance following isometric strength testing.

Design:

Cohort.

Setting:

Clinical.

Participants:

Thirty-four subjects (31±13yrs, 73±17kg, 170±12cm).

Interventions:

The force produced was measured in Newtons (N) with an isometric dynamometer. The force distance was the distance from center of joint to location of force applied was measured in meters to calculate torque …

A Retrospective Cohort Study Of Quickdash Scores For Three Hand Therapy Acute Upper Limb Conditions, Enrique V. Smith-Forbes, Dana M. Howell, Jason Willoughby, Donald G. Pitts, Timothy L. Uhl

Physical Therapy Faculty Publications

Introduction: The QuickDASH is a valid and reliable outcome measure widely used to assess the function and pain in arm, shoulder, and hand disabilities. A recent study introduced a QuickDASH 80% cut point test to gauge patients at risk of poor outcomes. However, the utility of this test has not been validated.

Purpose: To determine typical QuickDASH scores for three upper limb conditions and to test the sensitivity and specificity of the QuickDASH 80% cut point test in predicting patients at risk of poor outcomes.

Methods: This is a retrospective study with a total of 406 patient records for whom …

Pre-Operative Education For Total Knee Replacement: A Pilot Survey, Renee Causey-Upton, Dana M. Howell, Patrick H. Kitzman, Melba Custer, Emily V. Dressler

Physical Therapy Faculty Publications

Purpose: The structure of preoperative education programs used nationally for patients prior to total knee replacement (TKR) surgery has not been identified previously, thus hospitals across the United States lack a common standard for this preoperative education to ensure best patient outcomes. The purpose of this pilot survey study was to describe the content, providers, and delivery methods currently utilized to deliver preoperative education for total knee replacement in the United States. Method: Data were collected using an online survey developed by the authors based on review of literature and 3 preoperative programs and was distributed through the Research Electronic …

Timing And Amount Of Physical Therapy Treatment Are Associated With Length Of Stay In The Cardiothoracic Icu, Audrey M. Johnson, Angela N. Henning, Peter E. Morris, Alejandro G. Villasante Tezanos, Esther E. Dupont-Versteegden

Physical Therapy Faculty Publications

Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and …

Accuracy Of Recall Of Musculoskeletal Injuries In Elite Military Personnel: A Cross-Sectional Study, Mita Lovalekar, John P. Abt, Timothy C. Sell, Scott M. Lephart, Erin Pletcher, Kim Beals

Physical Therapy Faculty Publications

Background Self-reported data are often used in research studies among military populations.

Objective The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall.

Design Cross-sectional study.

Setting Applied research laboratory at a military installation.

Participants A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty.

Primary and secondary outcome measures Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The …

Reliability Of An Observational Method Used To Assess Tennis Serve Mechanics In A Group Of Novice Raters, Natalie L. Myers, W. Ben Kibler, Gilson J. Capilouto, Philip M. Westgate, Tony English, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: Previous research has developed an observational tennis serve analysis (OTSA) tool to assess serve mechanics. The OTSA has displayed substantial agreement between the two health care professionals that developed the tool; however, it is currently unknown if the OTSA is reliable when administered by novice users.

Purpose: The purpose of this investigation was to determine if reliability for the OTSA could be established in novice users via an interactive classroom training session.

Methods: Eight observers underwent a classroom instructional training protocol highlighting the OTSA. Following training, observers participated in two different rating sessions approximately a week apart. Each observer …

Dynamic Range Of Frontoparietal Functional Modulation Is Associated With Working Memory Capacity Limitations In Older Adults, Jonathan G. Hakun, Nathan F. Johnson

Physical Therapy Faculty Publications

Older adults tend to over-activate regions throughout frontoparietal cortices and exhibit a reduced range of functional modulation during WM task performance compared to younger adults. While recent evidence suggests that reduced functional modulation is associated with poorer task performance, it remains unclear whether reduced range of modulation is indicative of general WM capacity-limitations. In the current study, we examined whether the range of functional modulation observed over multiple levels of WM task difficulty (N-Back) predicts in-scanner task performance and out-of-scanner psychometric estimates of WM capacity. Within our sample (60–77 years of age), age was negatively associated with frontoparietal modulation range. …

The Effectiveness Of Cervical Traction And Exercise In Decreasing Neck And Arm Pain For Patients With Cervical Radiculopathy: A Critically Appraised Topic, Shelby Baez, Johanna M. Hoch, Timothy L. Uhl

Physical Therapy Faculty Publications

Clinical Question:

Is there evidence to suggest intermittent cervical traction with cervical and scapular strengthening exercises is more effective in decreasing neck and arm pain when compared with cervical and scapular strengthening exercises alone in nonoperative patients with cervical radiculopathy?

Clinical Bottom Line:

There is currently inconsistent, high-quality evidence that suggests that the use of intermittent cervical traction in addition to strengthening exercises is more effective at decreasing pain in nonoperative patients with cervical radiculopathy when compared with strengthening alone. Future research should continue to examine long-term outcomes associated with cervical radiculopathy patients who use intermittent cervical traction as an …

Conservative Treatment For Patients With Suspected Slap Tears: A Case Series, Stephanie D. Moore-Reed, Kelley A. Seekins, W. Ben Kibler, Aaron D. Sciascia, Timothy L. Uhl

Physical Therapy Faculty Publications

Objective: Outcome following non-operative management of superior labral anterior to posterior (SLAP) lesions has been under reported with little empirical data demonstrating the effectiveness of conservative treatment. Material and Methods: 10 patients, 5 matched pairs, presenting with symptoms consistent with a SLAP lesion performed a standardized phased rehabilitation program completing patient reported outcome (PRO) and pain measures before and following rehabilitation. Physical therapy notes and home exercise logs were reviewed and all exercises were recorded and coded using the phased rehabilitation protocol as a guide. At followup, patients were divided into two groups; responders and non-responders to treatment based on …

Endothelial Function Is Associated With White Matter Microstructure And Executive Function In Older Adults, Nathan F. Johnson, Brian T. Gold, Christopher A. Brown, Emily F. Anggelis, Alison L. Bailey, Jody L. Clasey, David K. Powell

Physical Therapy Faculty Publications

Age-related declines in endothelial function can lead to cognitive decline. However, little is known about the relationships between endothelial function and specific neurocognitive functions. This study explored the relationship between measures of endothelial function (reactive hyperemia index; RHI), white matter (WM) health (fractional anisotropy, FA, and WM hyperintensity volume, WMH), and executive function (Trail Making Test (TMT); Trail B - Trail A). Participants were 36 older adults between the ages of 59 and 69 (mean age = 63.89 years, SD = 2.94). WMH volume showed no relationship with RHI or executive function. However, there was a positive relationship between RHI …

Differential Requirement For Satellite Cells During Overload-Induced Muscle Hypertrophy In Growing Versus Mature Mice, Kevin A. Murach, Sarah H. White, Yuan Wen, Angel Ho, Esther E. Dupont-Versteegden, John J. Mccarthy, Charlotte A. Peterson

Physical Therapy Faculty Publications

Background: Pax7+ satellite cells are required for skeletal muscle fiber growth during post-natal development in mice. Satellite cell-mediated myonuclear accretion also appears to persist into early adulthood. Given the important role of satellite cells during muscle development, we hypothesized that the necessity of satellite cells for adaptation to an imposed hypertrophic stimulus depends on maturational age.

Methods: Pax7^CreER-R26R^DTA mice were treated for 5 days with vehicle (satellite cell-replete, SC+) or tamoxifen (satellite cell-depleted, SC-) at 2 months (young) and 4 months (mature) of age. Following a 2-week washout, mice were subjected to sham surgery or 10 day …

Subcutaneous Neurotophin 4 Infusion Using Osmotic Pumps Or Direct Muscular Injection Enhances Aging Rat Laryngeal Muscles, Richard D. Andreatta, Joseph C. Stemple, Tanya S. Seward, Colleen A. Mcmullen

Physical Therapy Faculty Publications

Laryngeal dysfunction in the elderly is a major cause of disability, from voice disorders to dysphagia and loss of airway protective reflexes. Few, if any, therapies exist that target age-related laryngeal muscle dysfunction. Neurotrophins are involved in muscle innervation and differentiation of neuromuscular junctions (NMJs). It is thought that neurotrophins enhance neuromuscular transmission by increasing neurotransmitter release. The neuromuscular junctions (NMJs) become smaller and less abundant in aging rat laryngeal muscles, with evidence of functional denervation. We explored the effects of NTF4 for future clinical use as a therapeutic to improve function in aging human laryngeal muscles. Here, we provide …

Reliability And Validity Of A Biomechanically Based Analysis Method For The Tennis Serve, Natalie L. Myers, W. Ben Kibler, Leah Lamborn, Belinda J. Smith, Tony English, Cale A. Jacobs, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: An observational tennis serve analysis (OTSA) tool was developed using previously established body positions from three-dimensional kinematic motion analysis studies. These positions, defined as nodes, have been associated with efficient force production and minimal joint loading. However, the tool has yet to be examined scientifically.

Purpose: The primary purpose of this investigation was to determine the inter-observer reliability for each node between two health care professionals (HCPs) that developed the OTSA, and secondarily to investigate the validity of the OTSA.

Methods: Two separate studies were performed to meet these objectives. An inter-observer reliability study preceded the …

Care Coordination For Community Transitions For Individuals Post-Stroke Returning To Low-Resource Rural Communities, Patrick H. Kitzman, Keisha Hudson, Violet Sylvia, Frances Feltner, Johnnie Lovins

Physical Therapy Faculty Publications

High rates of hospital readmissions have been shown within 12 months post-discharge from inpatient rehabilitation following stroke. Multiple studies coupled with our previous work indicate a need for care support for stroke survivors’ transitions to the community. The Kentucky Care Coordination for Community Transitions (KC³T) program was developed to provide access to medical, social, and environmental services to support community transitions for individuals with neurological conditions and their caregivers living in Kentucky. This program assessment was conducted to determine the effectiveness of using a specially trained community health worker to support community transitions. Thirty acute stroke survivors were …

Metformin To Augment Strength Training Effective Response In Seniors (Masters): Study Protocol For A Randomized Controlled Trial, Douglas E. Long, Bailey D. Peck, Jenny L. Martz, S. Craig Tuggle, Heather M. Bush, Gerald Mcgwin, Philip A. Kern, Marcas M. Bamman, Charlotte A. Peterson

Physical Therapy Faculty Publications

Background: Muscle mass and strength are strong determinants of a person’s quality of life and functional independence with advancing age. While resistance training is the most effective intervention to combat age-associated muscle atrophy (sarcopenia), the ability of older adults to increase muscle mass and strength in response to training is blunted and highly variable. Thus, finding novel ways to complement resistance training to improve muscle response and ultimately quality of life among older individuals is critical. The purpose of this study is to determine whether a commonly prescribed medication called metformin can be repurposed to improve the response to resistance …

Factors Influencing Final Outcomes In Patients With Shoulder Pain: A Retrospective Review, Timothy L. Uhl, Enrique V. Smith-Forbes, Arthur J. Nitz

Physical Therapy Faculty Publications

Study Design

Retrospective cohort.

Introduction

Rehabilitation interventions are commonly prescribed for patients with shoulder pain, but it is unclear what factors may help clinicians' prognosis for final outcomes.

Purpose of the Study

The purpose of this study is to determine what factors are the best predictors of improved patient-reported outcomes at discharge in patients with shoulder pain.

Methods

Retrospective chart review of 128 patients presenting with shoulder pain to an outpatient physical therapy clinic. Chart review captured data regarding patient demographics, treatment interventions, patient history, and patient-reported outcome scores. The primary dependent variable was the overall change score of the …

Tumor Necrosis Factor Alpha-Induced Recruitment Of Inflammatory Mononuclear Cells Leads To Inflammation And Altered Brain Development In Murine Cytomegalovirus-Infected Newborn Mice, Maria C. Seleme, Kate Kosmac, Stipan Jonjic, William J. Britt

Physical Therapy Faculty Publications

Congenital human cytomegalovirus (HCMV) infection is a significant cause of abnormal neurodevelopment and long-term neurological sequelae in infants and children. Resident cell populations of the developing brain have been suggested to be more susceptible to virus-induced cytopathology, a pathway thought to contribute to the clinical outcomes following intrauterine HCMV infection. However, recent findings in a newborn mouse model of the infection in the developing brain have indicated that elevated levels of proinflammatory mediators leading to mononuclear cell activation and recruitment could underlie the abnormal neurodevelopment. In this study, we demonstrate that treatment with tumor necrosis factor alpha (TNF-α)-neutralizing …

Effectiveness Of A Home-Based Eccentric-Exercise Program On The Torque-Angle Relationship Of The Shoulder External Rotators: A Pilot Study, Timothy L. Uhl, Thomas Rice, Brianna M. Papotto, Timothy A. Butterfield

Physical Therapy Faculty Publications

Context: The role of the rotator cuff is to provide dynamic stability to the glenohumeral joint. Human and animal studies have identified sarcomerogenesis as an outcome of eccentric training indicated by more torque generation with the muscle in a lengthened position. Objective: The authors hypothesized that a home-based eccentric-exercise program could increase the shoulder external rotators’ eccentric strength at terminal internal rotation (IR). Design: Prospective case series. Setting: Clinical laboratory and home exercising. Participants: 10 healthy subjects (age 30 ± 10 y). Intervention: All participants performed 2 eccentric exercises targeting the posterior shoulder for 6 wk using a home-based intervention …

Serve Volume: How Important Is It?, Natalie L. Myers, W. Ben Kibler, Timothy L. Uhl

Physical Therapy Faculty Publications

No abstract provided.

Development, Validation And Application Of A New Fornix Template For Studies Of Aging And Preclinical Alzheimer's Disease, Christopher A. Brown, Nathan F. Johnson, Amelia J. Anderson-Mooney, Gregory A. Jicha, Leslie M. Shaw, John Q. Trojanowski, Linda J. Van Eldik, Frederick A. Schmitt, Charles D. Smith, Brian T. Gold

Physical Therapy Faculty Publications

We developed a merged younger-older adult template of the fornix and demonstrated its utility for studies of aging and preclinical Alzheimer's disease (AD). In Experiment 1, probabilistic tractography was used to reconstruct the fornix in younger and older adults and successful streamlines were then averaged to create a merged template in standard space. The new template includes the majority of the fornix from the hippocampal formation to the subcallosal region and the thalamus/hypothalamus. In Experiment 2, the merged template was validated as an appropriate measure for studies of aging, with comparisons against manual tracing measures indicating identical spatial coverage in …