Medicine and Health Sciences Commons^™

Biomechanically-Consistent Skin Stretch As An Intuitive Mechanism For Sensory Feedback: A Preliminary Investigation In The Lower Limb, Jenny A. Kent

Physical Therapy Faculty Publications

The proprioceptive loss accompanied by lower limb amputation can impair function and mobility. We explore a simple, mechanical skin-stretch array configured to generate superficial tissue behaviour that might occur with movement about an intact joint. Four adhesive pads attached around the circumference of the lower leg were connected via cords to a remote “foot” mounted on a ball joint attached to the underside of a fracture boot, such that “foot” reorientation would result in skin stretch. In two discrimination experiments performed with and without the connection, with no view of the mechanism, and with minimal training, unimpaired adults (i) estimated …

Brain And Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review And Meta-Analysis, Kai-Yu Ho, Jing Nong Liang, Savanna Budge, Austin Madriaga, Kara Meske, Derrick Nguyenton

Physical Therapy Faculty Publications

Objective: To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP).

Methods: We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP.

Results: Eight studies …

Relationship Between Cognitive Performance And Lower Extremity Biomechanics: Implications For Sports-Related Concussion, Jason M. Avedesian, Tracey Covassin, Shelby Baez, Jennifer Nash, Ed Nagelhout, Janet S. Dufek

Physical Therapy Faculty Publications

Background: Collegiate athletes with prior sports-related concussion (SRC) are at increased risk for lower extremity (LE) injuries; however, the biomechanical and cognitive mechanisms underlying the SRC-LE injury relationship are not well understood. Purpose: To examine the association between cognitive performance and LE land-and-cut biomechanics among collegiate athletes with and without a history of SRC and to determine the association among multiple cognitive testing batteries in the same athlete cohort. Study Design: Controlled laboratory study. Methods: A cohort of 20 collegiate athletes with prior SRC (9 men, 11 women; mean ± standard deviation [SD] age, 20.5 ± 1.3 years; mean ± …

Neurophysiological Changes Of Brain And Spinal Cord In Individuals With Patellofemoral Pain: A Systematic Review And Meta-Analysis Protocol, Jing Nong Liang, Savanna Budge, Austin Madriaga, Kara Meske, Derrick Nguyenton, Kai-Yu Ho

Physical Therapy Faculty Publications

Introduction: Reduced neuromuscular control due to altered neurophysiological functions of the central nervous system has been suggested to cause movement deficits in individuals with patellofemoral pain (PFP). However, the underlying neurophysiological measures of brain and spinal cord in this population remain to be poorly understood. The purpose of this systematic review is to evaluate the evidence for altered cortical and spinal cord functions in individuals with PFP.

Methods and analysis: The protocol for conducting the review was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will systematically search the literature that examines cortical and …

Asymmetries In Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-Of-Concept Study, Kai Yu Ho, Andrew Murata

Physical Therapy Faculty Publications

Individuals with anterior cruciate ligament reconstruction (ACLR) are at a higher risk for subsequent anterior cruciate ligament (ACL) tears. Risk factors for ACL injuries likely involve a combination of anatomical, biomechanical, and neuromuscular factors. Dynamic knee valgus has been indicated as a possible biomechanical factor for future ACL injuries. Given that knee valgus is often accompanied by contralateral pelvic drop during single-leg activities, a dynamic valgus index (DVI) that quantifies combined kinematics of the knee and hip in the frontal plane has recently been developed. As the premise of asymmetrical DVI between limbs in the ACLR population has not been …

Neurophysiological Assessments Of Brain And Spinal Cord Associated With Lower Limb Functions In Children With Cerebral Palsy: A Protocol For Systematic Review And Meta-Analysis, Leonard Ubalde, Jing Nong Liang

Physical Therapy Faculty Publications

Background: Task-dependent neurophysiological adaptations in people with cerebral palsy have been examined using various techniques such as functional magnetic resonance imaging, peripheral nerve stimulation in order to assess H-reflexes, and transcranial magnetic stimulation. This activity-dependent plasticity is hypothesized to improve specific gross motor function in individuals with cerebral palsy. Although these adaptations have been examined extensively, most studies examined tasks utilizing the upper limbs. The aim of this review is to assess the neurophysiological adaptations of the central nervous system in individuals with cerebral palsy during lower limb functional tasks. Methods: A systematic review and meta-analysis will be conducted to …

Utilization Of Inertial Measurement Units For Determining The Sequential Chain Of Baseball Strike Posture, Yun-Ju Lee, Po-Chieh Lin, Ling-Ying Chen, Yu-Jung Cha, Jing Nong Liang

Physical Therapy Faculty Publications

The purpose of this study was to employ inertial measurement units (IMU) with an eyetracking device to investigate different swing strategies between two levels of batters. The participants were 20 healthy males aged 20 to 30 years old, with ten professional and ten amateur batters. Eye gaze position, head, shoulder, trunk, and pelvis angular velocity, and ground reaction forces were recorded. The results showed that professional batters rotated segments more rhythmically and efficiently than the amateur group. Firstly, the professional group spent less time in the preparation stages. Secondly, the maximum angular velocity timing of each segment of the professional …

Slow Walking In Individuals With Chronic Post-Stroke Hemiparesis: Speed Mediated Effects Of Gait Kinetics And Ankle Kinematics, Jing Nong Liang, Kai-Yu Ho, Yun-Ju Lee, Corey Ackley, Kiley Aki, Joshua Arias, Jassie Trinh

Physical Therapy Faculty Publications

Post-stroke rehabilitation often aims to increase walking speeds, as faster walking is associated with improved functional status and quality of life. However, for successful community ambulation, ability to modulate (increase and decrease) walking speeds is more important than walking continuously at constant speeds. Increasing paretic propulsive forces to increase walking speed has been extensively examined; however, little is known about the mechanics of slow walking post-stroke. The primary purpose of this study was to identify the effects of increased and decreased walking speeds on post-stroke kinetics and ankle kinematics. Fifteen individuals with chronic post-stroke hemiparesis and 15 non-neurologically impaired controls …

Immediate Effects Of Anodal Transcranial Direct Current Stimulation On Postural Stability Using Computerized Dynamic Posturography In People With Chronic Post-Stroke Hemiparesis, Jing Nong Liang, Leonard Ubalde, Jordon Jacklin, Peyton Hobson, Sara Wright-Avila, Yun-Ju Lee

Physical Therapy Faculty Publications

Postural stability is commonly decreased in individuals with chronic post-stroke hemiparesis due to multisystemic deficits. Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability, inducing neuroplastic changes to the targeted cortical areas and has been suggested to potentially improve motor functions in individuals with neurological impairments. The purpose of this double-blinded, sham-controlled study was to examine the acute effects of anodal tDCS over the lesioned motor cortex leg area with concurrent limits of stability training on postural control in individuals with chronic post-stroke hemiparesis. Ten individuals with chronic post-stroke hemiparesis received either anodal or sham tDCS …

Sound Effects On Standing Postural Strategies In The Elderly Via Frequency Analysis Approach, Yun-Ju Lee, Chang-Hsu Chen, Chao-Che Wu, Yu-Jung Chen, Jing-Nong Liang

Physical Therapy Faculty Publications

Sound and sound frequency could improve postural sway in the elderly. The power spectrum intervals of the center of pressure (COP) displacement are associated with different postural regulations, which could be revealed by frequency analysis. The aim of the study was to investigate the effects of sound on dual-tasking postural control and conduct frequency analysis to distinguish postural regulations in the elderly. Fifteen young and 15 older healthy participants were instructed to stand on a force platform and performed the Purdue Pegboard test while hearing 50 dB sounds with sound frequencies of 250 Hz, 1000 Hz, 4000 Hz, or no …

Altered Achilles Tendon Morphology In Individuals With Chronic Post-Stroke Hemiparesis: A Case Report, Jing Nong Liang, Kai-Yu Ho

Physical Therapy Faculty Publications

Background: Individuals post-stroke walk slowly and with more effort, which puts them at higher risks for falls. The slow walking speed results from insufficient propulsive forces generated by the paretic leg. Current rehabilitative efforts to improve walking function target increasing propulsive forces, but overlook the muscle-tendon unit. Case presentations: Two individuals with chronic post-stroke hemiparesis are presented. In both individuals post-stroke, paretic ankle plantarflexors presented with increased muscle tone. Gait kinetics revealed asymmetric propulsive forces, specifically, insufficient propulsive forces by the paretic legs, consistent with previous literature. Sonography revealed increased thickness of paretic Achilles tendon at the calcaneal insertion, in …

Characterizing Intersection Variability Of Butterfly Diagram In Post-Stroke Gait Using Kernel Density Estimation, Yun Ju Lee, Jing Nong Liang

Physical Therapy Faculty Publications

ackground:Center of pressure (COP) trajectory during treadmill walking have been commonly presented usingthe butterfly diagram to describe gait characteristics in neurologically intact and impaired individuals. However,due to the large amount of displayed information, the butterfly diagram is not an efficient solution to visualizelocomotor variability.Purpose:The purpose of this study was to evaluate post-stroke locomotor variability by applying Kernel densityestimation (KDE) on the intersections of the butterfly diagram, and to compare KDE derived metrics withconventional metrics of gait symmetry and variability.Methods:Bilateral toe-off(TO) and initial contact (IC) points of the butterfly diagram were determined to cal-culate the COP symmetry index and the intersections …

Improving Environmental Capacities For Health Promotion In Support Settings For People With Intellectual Disabilities: Inclusive Design Of The Dihasid Tool, Kristel Vlot-Van Anrooij, Thessa I. M. Hilgenkamp, Geraline L. Leusink, Anneke Van Der Cruijsen, Henk Jansen, Jenneken Naaldenberg, Koos Van Der Velden

Physical Therapy Faculty Publications

People with intellectual disabilities (ID) have unhealthier lifestyles than the general population. To sustainably improve their lifestyle and health status, a whole-system approach to creating healthy environments is crucial. To gain insight into how support for physical activity and healthy nutrition can be embedded in a setting, asset mapping can be helpful. Asset mapping involves creating a bottom–up overview of promoting and protective factors for health. However, there is no asset mapping tool available for ID support settings. This study aims to develop an asset mapping tool in collaboration with people with ID to gain insight into assets for healthy …

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

Physical Therapy Faculty Publications

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

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

Physical Therapy Faculty Publications

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

Patellar Tendon Morphology In Trans-Tibial Amputees Utilizing A Prosthesis With A Patellar-Tendon- Bearing Feature, Kai-Yu Ho, Michelle Harty, Jessica Kellogg, Kelly Teter, Szu-Ping Lee, Yu-Jen Chang, Gregory Bashford

Physical Therapy Faculty Publications

A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography …

Impaired H-Reflex Adaptations Following Slope Walking In Individuals With Post-Stroke Hemiparesis, Jing Nong Liang, Yun Ju Lee, Eric Akoopie, Brooke Conway Kleven, Trisha Koch, Kai-Yu Ho

Physical Therapy Faculty Publications

Background and Purpose: Short term adaptations in the Ia afferent-motoneuron pathway, as measured using the H-reflex, in response to altered ground reaction forces (GRFs) applied at the feet during slope walking have been observed in the non-impaired nervous system. The ability of the stroke-impaired nervous system to adapt to altered GRFs have not been examined. The purpose of this study was to examine the acute effects of altered propulsive and braking forces applied at the feet, which naturally occurs when walking on different slopes, on adaptations of the H-reflex pathway in individuals with chronic post-stroke hemiparesis.

Factors Related To Intra-Tendinous Morphology Of Achilles Tendon In Runners, Kai-Yu Ho, Ari Baquet, Yu-Jen Chang, Lung-Chan Chien, Michelle Harty, Gregory Bashford, Kornelia Kulig

Physical Therapy Faculty Publications

The purpose of this study was to determine and explore factors (age, sex, anthropometry, running and injury/pain history, tendon gross morphology, neovascularization, ankle range of motion, and ankle plantarflexor muscle endurance) related to intra-tendinous morphological alterations of the Achilles tendon in runners. An intra-tendinous morphological change was defined as collagen fiber disorganization detected by a low peak spatial frequency radius (PSFR) obtained from spatial frequency analysis (SFA) techniques in sonography. Ninety-one runners (53 males and 38 females; 37.9 ± 11.6 years) with 8.8 ± 7.3 years of running experience participated. Height, weight, and waist and hip circumferences were recorded. Participants …

Gender And Posture Are Significant Risk Factors To Musculoskeletal Symptoms During Touchscreen Tablet Computer Use, Szu-Ping Lee, Ya-Ting Hsu, Betina Bair, Marissa Toberman, Lung-Chang Chien

Physical Therapy Faculty Publications

[Purpose] To investigate the prevalence of neck and shoulder symptoms during the use of tablet computer, and to identify the risk factors associated with these symptoms. [Subjects and Methods] A cross-sectional survey was conducted to study tablet computer usage, posture during use, and neck and shoulder symptoms in 412 participants in a school setting. Significant risk factors for musculoskeletal symptoms during tablet computer use were identified. [Results] Overall prevalence of musculoskeletal symptoms during tablet computer use was 67.9% with greater prevalence of neck symptoms (neck: 84.6%; shoulder/upper extremity: 65.4%). Significant risk factors associated with symptoms during use were: current musculoskeletal …

Improving Outcomes By Implementing A Pressure Ulcer Prevention Program (Pupp): Going Beyond The Basics, Amparo Cano, Debbie Anglade, Hope Stamp, Fortunata Joaquin, Jennifer A. Lopez, Lori Lupe, Steven P. Schmidt, Daniel L. Young

Physical Therapy Faculty Publications

A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions …