Medicine and Health Sciences Commons^™

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 ± …

Interprofessional Inconsistencies In The Diagnosis Of Shoulder Instability: Survey Results Of Physicians And Rehabilitation Providers, Constantine P. Nicolozakes, Xinning Li, Timothy L. Uhl, Guido Marra, Nitin B. Jain, Eric J. Perreault, Amee L. Seitz

Physical Therapy Faculty Publications

Background: Clinicians of many specialties within sports medicine care for athletes with shoulder instability, but successful outcomes are inconsistent. Consistency across specialties in the diagnosis of shoulder instability is critical for care of the athlete, yet the extent of divergence in its diagnosis is unknown.

Hypothesis: Physicians differ from rehabilitation providers in which findings they deem clinically important to differentiate shoulder instability from impingement, and in how they diagnose athlete scenarios with atraumatic shoulder instability.

Study Design: Cross-sectional study.

Methods: Physicians (orthopaedic surgeons, primary care sports medicine physicians) and rehabilitation providers (physical therapists, athletic trainers) were asked via an online …

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 …

Myonuclear Transcriptional Dynamics In Response To Exercise Following Satellite Cell Depletion, Yuan Wen, Davis A. Englund, Bailey D. Peck, Kevin A. Murach, John J. Mccarthy, Charlotte A. Peterson

Physical Therapy Faculty Publications

Skeletal muscle is composed of post-mitotic myofibers that form a syncytium containing hundreds of myonuclei. Using a progressive exercise training model in the mouse and single nucleus RNA-sequencing (snRNA-seq) for high-resolution characterization of myonuclear transcription, we show myonuclear functional specialization in muscle. After 4 weeks of exercise training, snRNA-seq reveals that resident muscle stem cells, or satellite cells, are activated with acute exercise but demonstrate limited lineage progression while contributing to muscle adaptation. In the absence of satellite cells, a portion of nuclei demonstrates divergent transcriptional dynamics associated with mixed-fate identities compared with satellite cell replete muscles. These data provide …

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 …

Why We Can’T Wait, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

The Why, Where, And How Clinical Reasoning Model For The Evaluation And Treatment Of Patients With Low Back Pain, Sean P. Riley, Brian T. Swanson, Joshua Cleland

Physical Therapy Faculty Publications

Objective

The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.

Methods

This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.

Conclusions

This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's …

A Nation-Wide Survey Of High School Baseball Coaches’ Perceptions Indicates Their Arm Care Programs Play A Role In Injury Prevention, Kyle A. Matsel, E. E. Weiss, R. J. Butler, Matthew C. Hoch, Philip M. Westgate, Terry R. Malone, Timothy L. Uhl

Physical Therapy Faculty Publications

Background
Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches’ usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players.

Hypothesis/Purpose
The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced …

Identifying Risk Factors Of Upper Extremity Injuries In Collegiate Baseball Players: A Pilot Study, Robert Slowik, Christopher Morris, Matthew C. Hoch, Timothy L. Uhl

Physical Therapy Faculty Publications

Background
Repetitive pitching places tremendous forces on the shoulder and elbow which can lead to upper extremity (UE) or lower extremity (LE) overuse injuries.

Purpose
The purpose of this study was to evaluate pre-season physical measurements in collegiate baseball players and track in-season baseball throwing volume to determine which factors may predict throwing overuse injuries.

Study Design
Retrospective Cohort study.

Methods
Baseline preseason mobility, strength, endurance, and perception of function were measured in 17 collegiate baseball pitchers. Participants were then followed during the course of the season to collect rate of individual exposure, estimated pitch volume, and rating of perceived …

Icf Linking Of Patient-Reported Therapy Goals For Children With Acquired Upper Extremity Impairment, Jenny M. Dorich, Roger Cornwall, Timothy L. Uhl

Physical Therapy Faculty Publications

BACKGROUND: Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy.

PURPOSE: To determine the desired treatment outcomes of children with acquired upper extremity impairments.

STUDY DESIGN: Descriptive case series METHODS: Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of …

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 …

Gait And Balance Changes With Investigational Peripheral Nerve Cell Therapy During Deep Brain Stimulation In People With Parkinson’S Disease, Geetanjali Gera, Zain Guduru, Tritia R. Yamasaki, Julie A. Gurwell, Monica Chau, Anna Krotinger, Frederick A. Schmitt, John T. Slevin, Greg A. Gerhardt, Craig G. Van Horne, Jorge E. Quintero

Physical Therapy Faculty Publications

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the …

We Are People First, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Post-Operative Rehabilitation For Scapular Muscle Reattachment: A Case Report, Wendy Burke, W. Ben Kibler, Timothy L. Uhl

Physical Therapy Faculty Publications

Background and Purpose: Scapular muscle detachment is a rare orthopedic problem that has been described in the literature in patients following traumatic events involving traction, direct trauma, or a motor vehicle accident. The purpose of this case report is to describe the post-operative rehabilitation following scapular muscle reattachment surgery. Unique to this case report is the patient's perspective, an orthopedic physical therapist with 25 years of experience.

Case Description: A 47-year-old female physical therapist experienced a traction injury to bilateral upper extremities during a medical procedure resulting in bilateral rhomboid, and bilateral lower trapezius muscles were detached from the medial …

Injury Rates In Major League Baseball During The 2020 Covid-19 Season, Brooks N. Platt, Timothy L. Uhl, Aaron D. Sciascia, Anthony J. Zacharias, Nicole G. Lemaster, Austin V. Stone

Physical Therapy Faculty Publications

Background: The 2020 Major League Baseball (MLB) season was drastically altered because of the COVID-19 pandemic. The changes included an extended layoff between March and July as well as a shortened preseason.

Purpose/Hypothesis: To determine the incidence and epidemiology of MLB injuries in the abbreviated 2020 season compared with prior seasons. We hypothesized that there was an increase in the overall injury rate in the 2020 season compared with the 2018-2019 seasons and that it equally affected all body regions.

Study Design: Descriptive epidemiology study.

Methods: The MLB transactions database was queried to find players who had been placed on …

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 …

Reproducibility And Discriminant Validity Of The Posterior Shoulder Endurance Test In Healthy And Painful Populations, Neil A. Evans, Suzanne Konz, Arthur J. Nitz, Timothy L. Uhl

Physical Therapy Faculty Publications

OBJECTIVE: This investigation measured the reproducibility and discriminant validity of the Posterior Shoulder Endurance Test (PSET) on painful and non-painful populations.

DESIGN: Reliability and validity study.

SETTING: Laboratory setting.

PARTICIPANTS: Thirty subjects (male = 11; female = 19).

MAIN OUTCOME MEASURES: Time to failure (TTF) was the primary outcome measure to determine reliability of the PSET. Discriminant validity identified with receiver operator characteristic (ROC) curves utilized TTF separately in men and women since they used different loads.

RESULTS: There were 25/30 subjects (painful = 12; non-painful = 13) tested a second time. ICC, SEM, and MDC90 ranged respectively from 0.77, …

Physical Examination Findings In Patients With Protracted Concussion And The Impact Of An Integrative Concussion Rehabilitation Protocol, Lauren Ziaks, Chelsea Brown, Maura D. Iversen

Physical Therapy Faculty Publications

Purpose: To describe physical examination (PE) findings of individuals with protracted concussion recovery and evaluate an integrated primitive reflex (PR) disinhibition, vision, and vestibular rehabilitation intervention. Method: Retrospective study of 82 patients with protracted concussion (60.98% female) who received ≥ 2 phases of treatment. Following a baseline PE, patients completed the Post-Concussion Symptom Survey (PCSS), Activities-Based Balance Confidence Questionnaire (ABC), Dizziness Handicap Index (DHI), and Acquired Traumatic Brain Injury (aTBI) Vision Questionnaire. A subset of patients (Group 1), completed a final PE and second questionnaire administration. Descriptive statistics characterized the sample. T-tests and Wilcoxon rank sum tests compared characteristics of …

Flop To Flip: Integrating Technology And Team-Based Learning To Improve Student Engagement, Diana Veneri, Elizabeth M. Mongillo

Physical Therapy Faculty Publications

Purpose: The first attempt to develop and instruct a new course in evidence-based practice in a physical therapy curriculum proved problematic. The purpose of this paper is to describe the method of revising this traditionally taught course using a combination of flipping the classroom, team-based learning, and technology. Methods: Working with an Instructional Design Specialist, a weekly online preparatory module was created for each content topic using a variety of multimedia learning provisions including micro learning videos (PowerPoint with voiceover), transcript of the PowerPoint, a list of vocabulary words, reading, Quizlet, Flipgrids and Concept Checks. Each week’s module was introduced …

The Quality Of Intervention Reporting In Trials Of Therapeutic Exercise For Hip Osteoarthritis: A Secondary Analysis Of A Systematic Review, Louise C. Burgess, Thomas C. Wainwright, Khara A. James, Johan Von Heideken, Maura D. Iversen

Physical Therapy Faculty Publications

Background: Therapeutic exercise is recommended as a core treatment for hip osteoarthritis (HOA). Whilst it is widely accepted that exercise can improve pain and disability, optimal type and dose of exercise are yet to be agreed upon. This may, in part, be attributed to the wide variation and inadequate reporting of interventions within the literature. This study evaluates the quality of intervention reporting among trials of therapeutic exercise in HOA.

Methods: Randomised controlled trials (RCTs) were sourced in a systematic review, completed in August 2020. Two raters independently used the Template for Intervention Description and Replication (TIDieR) and Consensus on …

Development, Implementation And Outcomes Of A Quality Assurance System For The Provision Of Continuous Renal Replacement Therapy In The Intensive Care Unit, Eloy F. Ruiz, Victor M. Ortiz-Soriano, Monica Talbott, Bryan A. Klein, Melissa L. Thompson Bastin, Kirby P. Mayer, Emily B. Price, Robert Dorfman, Brandi N. Adams, Lisa J. Fryman, Javier A. Neyra, The University Of Kentucky Crrt Quality Assurance Group

Physical Therapy Faculty Publications

Critically ill patients with requirement of continuous renal replacement therapy (CRRT) represent a growing intensive care unit (ICU) population. Optimal CRRT delivery demands continuous communication between stakeholders, iterative adjustment of therapy, and quality assurance systems. This Quality Improvement (QI) study reports the development, implementation and outcomes of a quality assurance system to support the provision of CRRT in the ICU. This study was carried out at the University of Kentucky Medical Center between September 2016 and June 2019. We implemented a quality assurance system using a step-wise approach based on the (a) assembly of a multidisciplinary team, (b) standardization of …

Acute Skeletal Muscle Wasting And Dysfunction Predict Physical Disability At Hospital Discharge In Patients With Critical Illness, Kirby P. Mayer, Melissa L. Thompson Bastin, Ashley A. Montgomery-Yates, Amy M. Pastva, Esther E. Dupont-Versteegden, Selina M. Parry, Peter E. Morris

Physical Therapy Faculty Publications

BACKGROUND: Patients surviving critical illness develop muscle weakness and impairments in physical function; however, the relationship between early skeletal muscle alterations and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine whether changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge.

METHODS: Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of …

Microglia Prevent Beta-Amyloid Plaque Formation In The Early Stage Of An Alzheimer's Disease Mouse Model With Suppression Of Glymphatic Clearance, Weixi Feng, Yanli Zhang, Ze Wang, Hanrong Xu, Ting Wu, Charles Marshall, Junying Gao, Ming Xiao

Physical Therapy Faculty Publications

BACKGROUND: Soluble beta-amyloid (Aβ) can be cleared from the brain through various mechanisms including enzymatic degradation, glial cell phagocytosis, transport across the blood-brain barrier, and glymphatic clearance. However, the relative contribution of each clearance system and their compensatory effects in delaying the pathological process of Alzheimer's disease (AD) are currently unknown.

METHODS: Fluorescent trace, immunofluorescence, and Western blot analyses were performed to compare glymphatic clearance ability and Aβ accumulation among 3-month-old APP695/PS1-dE9 transgenic (APP/PS1) mice, wild-type mice, aquaporin 4 knock out (AQP4^−/−) mice, and AQP4^−/−/APP/PS1 mice. The consequence of selectively eliminating microglial cells, or downregulating apolipoprotein …

Training For A Marathon – Responding To A Pandemic, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Recovery From Covid-19 And Acute Respiratory Distress Syndrome: The Potential Role Of An Intensive Care Unit Recovery Clinic: A Case Report, Kirby P. Mayer, Jamie L. Sturgill, Anna G. Kalema, Melissa K. Soper, Sherif M. Seif, Evan P. Cassity, Jimmi Hatton Kolpek, Esther E. Dupont-Versteegden, Ashley A. Montgomery-Yates, Peter E. Morris

Physical Therapy Faculty Publications

Background

In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019.

Case Presentation

Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial …

Cardiorespiratory Fitness Diminishes The Effects Of Age On White Matter Hyperintensity Volume, Nathan F. Johnson, Ahmed A. Bahrani, David K. Powell, Gregory A. Jicha, Brian T. Gold

Physical Therapy Faculty Publications

White matter hyperintensities (WMHs) are among the most commonly observed marker of cerebrovascular disease. Age is a key risk factor for WMH development. Cardiorespiratory fitness (CRF) is associated with increased vessel compliance, but it remains unknown if high CRF affects WMH volume. This study explored the effects of CRF on WMH volume in community-dwelling older adults. We further tested the possibility of an interaction between CRF and age on WMH volume. Participants were 76 adults between the ages of 59 and 77 (mean age = 65.36 years, SD = 3.92) who underwent a maximal graded exercise test and structural brain …

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 …

Lessons Amidst A Pandemic, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.