Medicine and Health Sciences Commons^™

Developing Effective Online Training Tools For Maine Adaptive Sports And Recreation, Kristina Jamo, Emily Gall, Shannon Bergeland, Chelsea Paul

Research Report Papers

Background: Maine Adaptive Sports and Recreation (MASR) relies on volunteers to instruct their participants with disabilities to participate in a variety of adaptive sport programs. Volunteers must have a comprehensive understanding of participants’ health conditions to assist appropriately. MASR’s traditional training program lacked a formal curriculum and assessment of volunteer learning. Our purpose was to create online learning modules and determine whether implementing a massed or distributed schedule resulted in better long term retention. Methods: Two non-randomized groups of eleven adults were assigned to either an in-class, massed format (Group A) or an at-home, distributed schedule (Group B) to complete …

Comparison Of Apical Centring Ability Between Incisal-Shifted Access And Traditional Lingual Access For Maxillary Anterior Teeth, Yoshio Yahata, Yoshiko Masuda, Takashi Komabayashi

Dental Medicine Faculty Publications

The aim of this study was to compare the apical centring ability of incisal-shifted access (ISA) with that of traditional lingual access (TLA). Fifteen three-dimensional printed resin models were prepared from the computed tomography data for a human maxillary central incisor and divided into ISA (n=7), TLA (n=7), and control (n=1) groups. After access preparation, these models were shaped to the working length using K-files up to #40, followed by step-back procedures. An apical portion of the model was removed at 0.5 mm coronal to the working length. Microscopic images of each cutting surface were taken to measure the preparation …

Clinical Cases In Endodontics; Chapter 1: Introduction, Takashi Komabayashi

Dental Medicine Faculty Publications

Chapter 1 of Clinical Cases in Endodontics, a problem-based text that presents a wide range of real cases in endodontics. Clinical Cases in Endodontics presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in endodontic therapy. It begins with sets of cases illustrating the most common diagnoses and the steps involved in preparing a treatment plan. Subsequent chapters continue in this style, presenting exemplary cases as the basis of discussing various treatment options, including nonsurgical root canal treatment, re-treatment, periapical surgery, internal and external resorption, emergencies and trauma, and treating incompletely developed …

High Intensity Intervals And Gait Training For A Patient With Heart Failure And Parkinson Disease In A Skilled Nursing Facility: A Case Report, Kelly Fritz

Case Report Papers

Background and Purpose: Congestive Heart Failure is one of the most expensive conditions to manage medically and close to 20% of patients hospitalized for congestive heart failure are readmitted within 30 days. Fifty to seventy percent of people with Parkinson disease experience one or more falls in a 12- month period. The purpose of this case report is to describe the physical therapy management for a patient with acute congestive heart failure and Parkinson disease. Case description: The patient was an 85 year-old male with acute congestive heart failure and Parkinson disease. He received physical therapy at a skilled nursing …

The Role Of Physical Therapy Interventions For An Elderly Patient Following Surgical Fixation Of A Fracture Of The Femoral Shaft: A Case Report, Ashley Push

Case Report Papers

Background and Purpose: This case report contributes to and builds upon established knowledge about the importance of early weight bearing for patients who sustained a fracture and repair. The purpose of this case report is to document this patient’s response to skilled physical therapy in the inpatient setting, including functional mobility, gait training and therapeutic exercise to maximize the patient's functional ability prior to discharge home. Case Description: This report follows an 88-year old female who underwent open reduction and internal fixation of her right femoral shaft after sustaining a non-traumatic fracture. The patient was seen in the acute care …

Strength And Balance Training For A 29-Year-Old Female Who Sustained A Multifocal Stroke: A Case Report, Britney Simonton

Case Report Papers

Background and Purpose: While balance and strengthening are standard interventions for older patients who have sustained a stroke, there is very limited research on the most effective physical therapy rehabilitation for a young female who recently suffered a stroke. Therefore, the purpose of this case report was to investigate a comprehensive physical therapy program that included balance and strength training for a young female who recently sustained a multifocal stroke. Case description: The patient was a 29-year-old female who sustained a multifocal stroke in her left parietal, left frontal, and bilateral occipital lobes. She presented with right lower extremity weakness …

Outpatient Vestibular Rehabilitation For A Patient Three Months Post Acoustic Neuroma Resection: A Case Report, Joel Harrison

Case Report Papers

An acoustic neuroma, also known as a vestibular schwannoma, is a benign and slow growing primary intracranial tumor that originates from Schwann cells of the vestibular nerve within the inner ear. It is estimated that acoustic neuromas occur in 10-20 individuals per 1,000,000 annually in the United States. The tumor itself is often treated through surgical removal; however, the tumor and subsequent surgery frequently lead to vestibular nerve impairment. The vestibular nerve transmits sensory information to the brain from the peripheral vestibular system of the inner ear. Damage to one of the vestibular nerves may lead to vestibular dysfunction on …

Physical Therapy On The Function Of A Patient With Stage Iii Parkinson’S Disease: A Case Report, Kelly Trancygier

Case Report Papers

Background and Purpose: Parkinson’s disease (PD) is typically diagnosed in individuals over the age of 60. The patient in this case report was diagnosed at age 49 which is considered young-onset PD. PD affects 1.5% of the US population over the age of 65. Although there is no cure and the disease itself is not fatal, its effects can be very debilitating. PD typically occurs in five stages. Case Description: The patient was a 54-year-old female that presented to physical therapy with a diagnosis of PD. Initially, she presented with impaired balance, limited range of motion (ROM), impaired standing posture, …

The Effect Of A Stability And Strengthening Program On The Oswestry Disability Index In A 14-Year-Old Patient With Spondylolisthesis: A Case Report, Hormoz Maragoul

Case Report Papers

Background and Purpose: Spondylolisthesis is a condition that describes the anterior translation of the cephalad vertebral segment of the skeletal spine relative to the caudal segment. This condition comes about by forces of gravity acting through the lordotic curve of the lumbar spine. Repetitive extension movements and weakened stabilizing muscles of the trunk like the abdominals and the gluteals may also play a role in contributing to spondylolisthesis. There is an increase in incidence rate of spondylolisthesis in adolescents who participate in sports involving repetitive extension motions. The purpose of this study is to examine the effectiveness of physical therapy …

Balance & Fall Prevention Rehabilitation Program For A 77-Year-Old Patient Following A Trimalleolar Fracture: A Case Report, Kathryn Judd

Case Report Papers

Background and Purpose: Ankle fractures are one of the most common injuries amongst the elderly, with an incidence rate of approximately 174 cases per 100,000 persons per year. Balance training has been a typical component of a physical therapy (PT) program following ankle fractures. Fall prevention programs have been shown to decrease fall risk by 13% to 40%. There is limited research investigating a combined balance training and fall prevention program after an ankle fracture. Therefore, the purpose of this case report was to describe a PT program combining balance training and fall prevention strategies for an elderly patient after …

Outpatient Physical Therapy Management Of A Total Knee Arthroplasty With Severe Contralateral Knee Osteoarthritis: A Case Report, Michael Ikemura

Case Report Papers

Background and Purpose: Osteoarthritis (OA) of the knee is a common cause of severe pain, disability within the community, and dependence on others. If conservative treatments fail, orthopedic surgeons often perform a total knee arthroplasty (TKA), in which damaged articular parts of the knee are resurfaced with prosthetics. To maximize physical function, the underlying cause of gait speed limitation must be determined and treated. The purpose of this case report was to examine the impairments following a TKA with concurrent severe OA of the contralateral knee, develop an effective plan of care, describe physical therapy (PT) interventions, and report the …

Physical Therapy For Low Back Pain With A Focus On Mckenzie Method For Diagnosis And Treatment: A Case Report, Macey N. Berube

Case Report Papers

Background and Purpose: Low back pain (LBP) is a common diagnosis seen in physical therapy (PT). It is thought to affect 80% of the population over their lifespan, and it keeps them out of work, affects daily activity, and decreases quality of life. PT is a noninvasive form of treatment that may include manual therapy, physical exercise, deep heat modalities, or a combination. The purpose of this case report is to review the McKenzie method combined with a conventional PT program for a patient with a recurring episode of chronic LBP. Case Description: The patient was a 72-year-old male referred …

Utilization Of Task-Oriented Training To Restore Independence In A Patient With Encephalitis In The Intensive Care Unit: A Case Report, Victoria Perez

Case Report Papers

Background and Purpose: Bacterial meningitis is acute inflammation of the meninges which can result in significant morbidity and mortality. There are 15,000 to 25,000 cases of bacterial meningitis in the United States yearly and it is one of the top ten causes of infection-related deaths worldwide. Bacterial Meningitis is commonly complicated by encephalitis. The purpose of the case report is to describe physical therapy (PT) rehabilitation in the intensive care unit (ICU) with the goal of increasing the independence of the patient, diagnosed with encephalitis secondary to bacterial meningitis, to prior level of function through task-oriented training in order to …

A Comprehensive Pt Program Utilizing An Alterg Treadmill For A Patient With Lower Extremity Fractures And Charcot-Marie-Tooth Disease: A Case Report, Mark Whitsitt

Case Report Papers

Background and Purpose: People with Charcot-Marie-Tooth (CMT) disease have a greater risk of falls and subsequent fractures. There is a scarcity of information regarding the most effective rehab protocol for a patient with lower extremity fractures and CMT disease. Utilization of the AlterG® has been shown to promote early mobility in patients with an orthopedic diagnosis, which is also vital for CMT patients, but has not been fully investigated. The purpose of this case report was to investigate a comprehensive physical therapy program, including use of the AlterG® treadmill, for a patient with lower extremity fractures and CMT disease. Case …

Vestibular Rehabilitation For A Geriatric Patient With Benign Paroxysmal Positional Vertigo Treatment Failure: A Case Report, Clare Roeder

Case Report Papers

Background & Purpose: Benign Paroxysmal Positional Vertigo (BPPV), the most common vestibular disorder, is treated via a canalith repositioning maneuver (CRM), often providing rapid and lasting resolution of symptoms. However, 31% to 61% of patients experience residual dizziness (RD) post-treatment. For these cases, known as BPPV treatment failures, vestibular rehabilitation (VR) is recommended. Limited evidence exists for the specifics of treatment. This report documents VR of an older patient following BPPV treatment failure. Case Description: The patient was a 77 year-old male referred to outpatient physical therapy with a diagnosis of peripheral vertigo. He reported unsteadiness and dizziness during gait …

The Use Of Manual Lumbar Traction And Therapeutic Exercise In The Treatment Of A Patient With Low Back Pain: A Case Report, Kyle Rasmussen

Case Report Papers

Background: Low back pain is a common condition encountered in physical therapy practice. Manual lumbar traction and therapeutic exercise are two of the most common treatments used by physical therapists in the treatment of low back pain, but there is limited research investigating the combined effects of these interventions on low back pain. The purpose of this case report was to investigate the effects of a combined therapy approach of manual lumbar traction and therapeutic exercise as part of a compressive physical therapy plan of care for treatment of low back pain. Case Description: The patient was a 48-year-old female …

Acute Care Physical Therapy Status Post Laparoscopic Loop Sigmoid Colostomy For A Patient With Colorectal Cancer: A Case Report, Elizabeth Race

Case Report Papers

Background and Purpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, with an increasing prevalence in the United States. Surgical treatment is common and the American Society of Enhanced Recovery (ASER) established fast track protocols to reduce recovery time and length of stay in the hospital. Early mobilization is a key component of these protocols. The purpose of this case report is to describe the acute physical therapy (PT) for a patient who received a laparoscopic loop sigmoid colostomy. Case Description: The patient was a 73-year-old male admitted to the hospital to receive surgery for a permanent colostomy …

The Physical Therapy Management Of A Patient With Chronic Shoulder Dislocations And Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report, Lindsey Umapathy

Case Report Papers

Background and Purpose: While current literature has studied the role of physical therapy interventions when treating multi-directional shoulder instability, most evidence has focused on younger athletes with no co-morbidities. There is less research on older adults with shoulder instability, and no research on the effects of a fatigue dominant progressive neuropathy, such as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), on the management of recurrent shoulder dislocations. The purpose of this case report is to describe the physical therapy management and recovery of an individual with chronic shoulder instability/dislocations and CIDP. Case Description: The patient was a 62-year- old female who came …

Adult Scoliosis And Chronic Low Back Pain With Land And Aquatic Based Physical Therapy: A Case Report, Thomas Kent

Case Report Papers

Background and Purpose: Scoliosis is commonly an idiopathic condition that occurs in approximately 2-3% of the population and is defined by a lateral spinal curvature of greater than 10 degrees. Common symptoms associated with scoliosis include decreased pulmonary function and chronic spinal pain. Depending on the degree of curvature bracing or surgery may be required. The purpose of this case study is to evaluate the effects of an aquatic and land based exercise program on an adult with severe, untreated, early onset scoliosis. Case Description: The patient was a 55-year-old female with a history of scoliosis and recent onset of …

Graston Technique Used In The Treatment Of Patellofemoral Pain In An Ultimate Frisbee Player: A Case Report, Patricia Dobrowski

Case Report Papers

Background and Purpose: Graston® Technique (GT) is an instrumented tool used in rehab shown to improve soft tissue injuries. While studies have shown GT to be effective with injuries such as achilles tendinitis, it has not been extensively studied in patients with patellofemoral pain. The purpose of this case report was to investigate a plan of care that included GT in a 38-year-old male ultimate frisbee athlete with patellofemoral pain. Case Description: The patient was an active 38-year-old father of four and a recreational ultimate frisbee player. His chief complaints were pain in the lateral compartment of the right knee, …

Defining The Epichromatin Epitope, Travis J. Gould, Katalin Tóth, Norbert Mücke, Jörg Langowski, Alexandra S. Hakusui, Ada L. Olins, Donald E. Olins

Pharmaceutical Sciences Faculty Publications

Epichromatin is identified by immunostaining fixed and permeabilized cells with particular bivalent anti-nucleosome antibodies (mAbs PL2-6 and 1H6). During interphase, epichromatin resides adjacent to the inner nuclear membrane; during mitosis, at the outer surface of mitotic chromosomes. By STED (stimulated emission depletion) microscopy, PL2-6 stained interphase epichromatin is ∼76 nm thick and quite uniform; mitotic epichromatin is more variable in thickness, exhibiting a “wrinkled” surface with an average thickness of ∼78 nm. Co-immunostaining with anti-Ki-67 demonstrates Ki-67 deposition between the PL2-6 “ridges” of mitotic epichromatin. Monovalent papain-derived Fab fragments of PL2-6 yield a strikingly different punctate “chromomeric” immunostaining pattern throughout …

Hypertonic Saline Versus Mannitol To Improve Brain Relaxation In Craniotomy: A Case Study, Morgan Cornell

Nurse Anesthesia Student Capstones

In neurosurgical procedures, including craniotomy for tumor, neurosurgeons often require a reduction of brain swelling to optimally perform the surgery. The reduction of brain swelling is termed brain relaxation. The anesthesia professional can accomplish brain relaxation using multiple techniques. One such technique is the infusion of certain intravenous fluids to change the osmotic pressure within the cranial vault thereby reducing brain edema (Jaffe, 2014). Highly osmolar fluids such as mannitol and hypertonic saline can be infused to decrease brain edema. Currently, mannitol remains the gold standard for medical treatment of intracranial pressure in neurosurgical procedures (Marko, 2012). This review seeks …

The Impact Of Intraoperative Goal-Directed Fluid Therapy, Marc Yacovone

Nurse Anesthesia Student Capstones

Anesthetists provide intra-operative fluid therapy by utilizing a variety of different methods. Deciding on the appropriate method is multifaceted, and the choice of method is a determinate of safe and effective outcomes. Camach-Navarro et al. (2015) determined that postoperative complications are linked to either giving too much or too little fluid. Unfortunately, the deleterious effects of improper fluid therapy are often overlooked.

Minor surgical procedures which result in little to no blood loss, often lead to positive outcomes using the fixed volume calculation approach to fluid therapy. However, when major surgical procedures are performed on sick patients a fluid management …

The Role Of Platelet Rich Plasma In Pain Management And Decrease In Opioid Use, Sara Cunha

Nurse Anesthesia Student Capstones

Platelet-rich plasma, also known as PRP, has become increasingly popular for the treatment of orthopedic injuries and symptomatic pain that results from such injuries. By promoting a localized inflammatory response, PRP injections increase blood flow to the injured area and expedite the healing process, thereby leading to pain relief. PRP has the potential to be a key player in the future of pain management. However, current evidence of the impact of PRP on pain relief is controversial. This paper aims to review the most current randomized controlled trials evaluating the efficacy of PRP in pain relief in a variety of …

Neurotoxic Effects Of Anesthesia On The Developing Brain, Nicole Hachey

Nurse Anesthesia Student Capstones

Each year, thousands of neonates receive anesthesia and/or sedation for various surgical procedures. With advancements in neonatal care and surgical techniques, the number of infants receiving anesthesia globally will continue to increase. A relatively large and growing body of literature suggests that exposure to general anesthetics can be detrimental to the developing brain. Based upon various animal studies, it is thought that exposure of the immature brain to anesthetic agents may result in apoptosis, neurodegeneration and ultimately long-term cognitive deficiencies (Walters & Paule, 2016). This information presents a dilemma for practitioners when caring for a neonate requiring a surgical procedure, …

Thoracic Epidural Versus Continuous Intercostal Catheter For Patients Undergoing Video Assisted Thoracoscopic Surgery (Vats), Brittany Guilmet

Nurse Anesthesia Student Capstones

Advances in technology have pushed many practitioners towards the implementation of minimally invasive surgery. Many different specialties have rapidly adopted this new approach and patient outcomes have improved as a result of this transition. One specialty, thoracic surgery, has evolved with this change through the development of video assisted thoracoscopic surgery (VATS). Despite improved patient outcomes, thoracic surgery remains one of the most painful procedures that a patient can endure. Although there are many different analgesic modalities available, the gold standard for post-operative analgesia in this patient population remains unknown. The aim of this literature review is to compare the …

Regional Anesthesia And Breast Cancer Recurrence, Michael Dunnington

Nurse Anesthesia Student Capstones

Breast cancer is the most common type of cancer in women in the United States, and surgical resection is the definitive treatment. However, cancer recurrence and metastasis remains a concern for the lifetime of the patients affected. Therefore, much interest has been focused on how anesthetic technique may impact the rates of cancer recurrence and metastasis following breast cancer surgery. In this review, the potential for regional analgesia to reduce the recurrence rate of breast cancer post-operatively is discussed. Supporting evidence from multiple studies is presented, along with a discussion of potential areas of future research that is needed. At …

Dexmedetomidine In The Prevention Of Emergence Delirium In Children, Lauren Anderson

Nurse Anesthesia Student Capstones

This review examines the use of intravenous dexmedetomidine in the role of decreasing or preventing emergence delirium in pediatric patients undergoing ambulatory surgery. The included randomized controlled trials evaluated the administration of dexmedetomidine, whether as a bolus, infusion, or in combination, and its effectiveness in preventing or reducing emergence delirium. The analysis scales for emergence delirium varied between studies, and it was noted that multiple scale components overlapped with pain scale components used in the trials. It has also been noted that differentiating between pain and emergence delirium can be challenging for clinicians (Somaini, Engelhardt, Fumagalli & Ingelmo, 2016). To …

Clinical Performance And The Student Registered Nurse Anesthetist, Alyson Cronan

Nurse Anesthesia Student Capstones

The clinical component of graduate nurse anesthesia programs continues to be the key factor in evaluating and ensuring student success. Clinical experience has a direct correlation on student development in areas of self-awareness, psychomotor proficiency, critical thinking and professionalism. To effectively create a positive and motivating learning environment for the student registered nurse anesthetist (SRNA), the literature recommends instructors theoretically adapt to the individual learning style of the student, and incorporate various teaching techniques and modalities clinically. The overall goal of the clinical rotation is to establish an atmosphere where an individual can modify learning and skills. Positive, respectful and …

A Systematic Analysis On Opioid-Free General Anesthesia Versus Opioid-Based General Anesthesia For Bariatric Surgery, Ina Basha

Nurse Anesthesia Student Capstones

One-third of the American adult population is considered overweight, a figure that is still on the rise. Obesity negatively impacts every organ system in the human body. When minimally invasive strategies such as life style changes fail, bariatric surgery procedures have become the other option. The purpose of this systemic analysis is to look at the outcomes of post-operative pain, post-operative nausea and vomiting (PONV), and the length of stay required in the postanesthesia care unit (PACU) in obese adults undergoing bariatric surgery using opioid-free general anesthesia compared to opioid-based general anesthesia. The studies included in this systematic analysis conclude …