Medicine and Health Sciences Commons^™

The Effects Of External Focus Of Attention Exercise Rehabilitation On Dual Task Walking In Parkinson's Disease, Eric N. Beck

Theses and Dissertations (Comprehensive)

Parkinson’s disease impairs control of well-learned movements, and therefore, individuals with Parkinson’s disease are forced to walk with greater conscious control. This causes difficulties while walking and completing a secondary task simultaneously (dual tasking), in that distractions from conscious control of walking increase the risk of falls and injury. Although, attention-based exercise may be a potential avenue to decrease the demands associated with walking in Parkinson’s disease. For example, an external focus of attention (on manipulated objects) has been found to recruit the networks that are important for walking with little conscious control (automatic control networks). In contrast, an internal …

Isosorbide Mononitrate In Heart Failure With Preserved Ejection Fraction., Margaret M. Redfield, Kevin J. Anstrom, James A. Levine, Gabe A. Koepp, Barry A. Borlaug, Horng H. Chen, Martin M. Lewinter, Susan M. Joseph, Sanjiv J. Shah, Marc J. Semigran, G. Michael Felker, Robert T. Cole, Gordon R. Reeves, Ryan J. Tedford, W.H. Wilson Tang, Steven E. Mcnulty, Eric J. Velazquez, Monica R Shah, Eugene Braunwald

Division of Cardiology Faculty Papers

BACKGROUND: Nitrates are commonly prescribed to enhance activity tolerance in patients with heart failure and a preserved ejection fraction. We compared the effect of isosorbide mononitrate or placebo on daily activity in such patients.

METHODS: In this multicenter, double-blind, crossover study, 110 patients with heart failure and a preserved ejection fraction were randomly assigned to a 6-week dose-escalation regimen of isosorbide mononitrate (from 30 mg to 60 mg to 120 mg once daily) or placebo, with subsequent crossover to the other group for 6 weeks. The primary end point was the daily activity level, quantified as the average daily accelerometer …

Quality And Cost Of Diabetes Mellitus Care In Community Health Centers In The United States, Patrick Richard, Peter Shin, Tishra Beeson, Laura S. Burke, Susan F. Wood, Sara Rosenbaum

All Faculty Scholarship for the College of the Sciences

Objective

To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings.

Research Design and Methods

We used data from the 2005–2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to …

College Undergraduate Students’ Self-Rating Of Their Physical Activity Involvement Over A 7-Day Period, Wycliffe W. Njororai Simiyu, Fletcher J. Njororai

Health and Kinesiology Faculty Publications and Presentations

Purpose: To establish the college undergraduate students’ self-rated physical activity involvement over a 7-day period. Methodology: The study utilized the survey method using the International Physical Activity Short Version of the Questionnaire (IPAQ). The purpose of the questionnaires is to provide a common instrument that can be used to obtain internationally comparable data on health-related physical activity. The study was undertaken at a medium sized campus in the South Western part of U.S.A., with respondents drawn from the College of Nursing and Health Sciences. Results: A total of 220 students responded to the questionnaire. Most of the respondents, 182 (82.73%) …

Do Three Different Passive Assessments Of Quadriceps Spasticity Relate To The Functional Activity Of Walking For Children Diagnosed With Cerebral Palsy?, Hank White, Tim L. Uhl, Sam Augsburger

Physical Therapy Faculty Publications

A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression …

Computerized Adaptive Tests Detect Change Following Orthopaedic Surgery In Youth With Cerebral Palsy., M J Mulcahey, Mary D Slavin, Pengsheng Ni, Lawrence C Vogel, Scott H Kozin, Stephen M Haley, Alan M Jette

Department of Occupational Therapy Faculty Papers

BACKGROUND: The Cerebral Palsy Computerized Adaptive Test (CP-CAT) is a parent-reported outcomes instrument for measuring lower and upper-extremity function, activity, and global health across impairment levels and a broad age range of children with cerebral palsy (CP). This study was performed to examine whether the Lower Extremity/Mobility (LE) CP-CAT detects change in mobility following orthopaedic surgery in children with CP.

METHODS: This multicenter, longitudinal study involved administration of the LE CP-CAT, the Pediatric Outcomes Data Collection Instrument (PODCI) Transfer/Mobility and Sports/Physical Functioning domains, and the Timed "Up & Go" test (TUG) before and after elective orthopaedic surgery in a convenience …

Locomotor Adaptation Is Influenced By The Interaction Between Perturbation And Baseline Asymmetry After Stroke., Christine M. Tyrell, Erin Helm, Darcy S. Reisman

Department of Physical Therapy Faculty Papers

Stroke survivors without cerebellar involvement retain the ability to adapt to the split-belt treadmill; however it has been suggested that their rate of adaptation may be slowed compared to those who are neurologically intact. Depending on limb placement, the split-belt treadmill can be configured to either exaggerate baseline asymmetry, or reduce it, which may affect the behavior of adaptation or de-adaptation. The objectives of this study were to characterize the rate and magnitude of locomotor (de)adaptation in chronic stroke survivors compared to healthy matched subjects, and to evaluate whether exaggeration or reduction of baseline asymmetry impact the responses. Seventeen stroke …

Walking Pattern In Children With And Without Down Syndrome Via A Force-Driven Harmonic Oscillator Model, Jianhua Wu, Matthew Beerse, Toyin Ajisafe, Huaqing Liang

Physical Therapy Faculty Research

Children with Down syndrome (DS) display poorer kinematic and kinetic patterns of walking than typically developing ( TD) children. However, little is known on neuromuscular control in children with DS during locomotion. A force driven harmonic oscillator (FDHO) model sheds light on general muscular activation with respect to the gravitational load of the thigh-shank-foot system. The K/G ratio derived from this model represents a scaling between the elastic restoring torque from muscles and soft tissues and the gravitational torque from the weight of the leg during walking. The K/G ratio has shown different muscular function in infant walkers and children …

Children Display Adult-Like Kinetic Pattern In The Time Domain But Not In The Frequency Domain While Walking With Ankle Load, Jianhua Wu, Toyin Ajisafe, Matthew Beerse, Huaqing Liang

Physical Therapy Faculty Research

While external load is added during locomotion, humans increase the activation of extensors during stance and suppress the initiation of flexors during swing. External load at the ankles, rather than on the waist or thigh, elicits higher activities from ankle extensors, and increases stride length and decreases cadence in adults. Spatiotemporal and kinematic patterns become adult-like in children aged 5-8 years. However, little is known if children show adult like kinetic patterns while walking with external load This study aimed to investigate differences in kinetic patterns between children and adults while walking with external ankle load using both time and …

The Evolution Of Physical Activity Promotion, Elizabeth Richards

School of Nursing Faculty Publications

Overview: A physically active lifestyle has numerous physical and mental health benefits for patients of all ages. Despite these significant benefits, a majority of Americans do not meet current physical activity guidelines. Health care providers, especially nurses, play a vital role in physical activity promotion. Over the past several decades, exercise and physical activity guidelines have evolved from a focus on structured, vigorous exercise to a focus on moderate-intensity “lifestyle” physical activity. The author updates nurses on physical activity guidelines and provides tips for promoting physical activity, with a focus on lifestyle activities such as walking to work. This article …

School Administrators' Perceptions Of Factors That Influence Children's Active Travel To School, Anna Greer, Delores Pluto, Olga Ogoussan, Jorge Banda

Anna E. Greer

BACKGROUND: Increasing children's active travel to school may be 1 strategy for addressing the growing prevalence of obesity among school age children. Using the School Travel Survey, we examined South Carolina school district leaders' perceptions of factors that influence elementary and middle school students walking to school. METHODS: Frequency distributions and chi-square tests were used to analyze the survey responses; open-ended questions were reviewed qualitatively for recurring topics and themes. RESULTS: School and district leaders (N = 314) most often reported street crossing safety (54.0%) and number of sidewalks (54.0%) as priority factors that should be addressed to increase students' …

Comparing Functional Motor Control And Gait Parameters In Children With Autism To Those Of Age-Matched Peers Who Are Typically Developing, Patricia Stevenson, Samantha Novotny, Jillian May, Christopher Ancell

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare motor performance of children with Autism Spectrum Disorder (ASD) to that of age-matched peers who are typically developing (TD) on motor control tasks plus symmetry and variability of gait parameters across four walking conditions. A sample of convenience of children with ASD (n=6) and peers who are TD (n=6) were recruited. Motor control was assessed using initiation and completion times on the Timed Up and Go (TUG) test. Gait parameters were collected using a computerized walkway under four trial conditions: 1) walking at self-selected velocity (SSV); 2) walking during a tray-carrying task …

The Feasibility Of Delivering A Home-Based Motivational Exercise Program To African-American Breast Cancer Survivors, Denise Spector, Claudio Battaglini

Journal of Health Disparities Research and Practice

Most African-American breast cancer survivors do not meet current exercise recommendations for cancer survivors, which include both aerobic and strength-training exercises. This pilot study tested the feasibility of delivering a home-based exercise intervention to African-American breast cancer survivors. Sedentary African-American breast cancer survivors were recruited for a 16-week motivational home-based progressive aerobic and strength-training exercise pilot study. Participants completed weekly exercise logs and received weekly phone calls. To assess feasibility, we evaluated recruitment, retention, and adherence rates, as well as participant acceptance and safety. 17 women enrolled; 13 completed the intervention (76%). Participants had moderately-high adherence (70%) to walking goals, …

Walking Speed: The Functional Vital Sign, Addie Middletown, Stacy Fritz, Michelle M. Lusardi

All PTHMS Faculty Publications

Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the “sixth vital sign”. By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual's WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding …

Stroke-Related Effects On Maximal Dynamic Hip Flexor Fatigability And Functional Implications, Henry Kuhnen, Megan M. Rybar, Tanya Onushko, Ryan E. Doyel, Sandra K. Hunter, Brian D. Schmit, Allison Hyngstrom

Exercise Science Faculty Research and Publications

Introduction: Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. Methods: Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. Results: Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last …

Gender Differences In Neighborhood Walking In Older Adults, N. A. Gallagher, P. J. Clarke, Kimberlee A. Gretebeck

College of Nursing Faculty Research and Publications

Objective: This study examined mobility, self-efficacy, outcome expectations, neighborhood (density, destinations, and design), and neighborhood walking in older men (n = 106, 60-99 years, M = 76.78, SD = 8.12) and women (n = 216, 60-99 years, M = 75.81, SD = 8.46).

Method/Results: In hierarchical regression, the variables explained 32% of the variance in neighborhood walking in men (p < .001) and 27% of the variance in women (p < .01). Self-efficacy (β = .49, p < .01), density (β= .22, p < .05), and design (β= .21, p = .05) were associated with walking in men. Significant design characteristics included sidewalks (β= .25, p < .05) and crime (β= .36, p < .01). In women, self-efficacy (β= .48, p < .001) and destinations (β= .15, p < .05) were associated with walking. Walking was associated with self-efficacy for walking despite individual barriers in women (β= .38, p < .001) and neighborhood barriers in men (β= .30, p < .05).

Conclusion: Walking interventions targeting older women should incorporate local destinations. In older …

Physical Activity During Pregnancy In A Prospective Cohort Of British Women: Results From The Avon Longitudinal Study Of Parents Of Children, Jihong Liu, Steven Blair, Yangping Teng, Andrew Ness, Debbie Lawlor, Chris Riddoch

Jihong Liu

No abstract provided.

Physical Activity During Pregnancy In A Prospective Cohort Of British Women: Results From The Avon Longitudinal Study Of Parents And Children, Jihong Liu, Steven Blair, Yanping Teng, Andrew Ness, Debbie Lawlor, Chris Riddoch

Jihong Liu

No abstract provided.

Biomechanical Analysis Of Gait Kinetics Resulting From Use Of A Vacuum Socket On A Transtibial Prosthesis, Maria De Lourdes Ramos Gonzalez

Honors College Theses

The technology and design of lower limb prosthetics have evolved greatly since their introduction. The current study proposed to compare the effects of a conventional pin socket attachment and a vacuum socket attachment for a transtibial amputee. Whereas traditional measurements of gait utilize force plates and camera systems, this study made use of a small tri-axial load cell located at the base of the socket to measure the forces and moments exerted during a regular gait cycle. The hypothesis tested stated that a vacuum pump socket attachment, when compared to a non-vacuum (pin) socket, will have a significant effect on …

Adult-Acquired Flatfoot Deformity And Age-Related Differences In Foot And Ankle Kinematics During The Single-Limb Heel-Rise Test, Ruth L. Chimenti, Joshua Tome, Cody D. Hillin, Adolph S. Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

STUDY DESIGN: Cross-sectional laboratory study.

OBJECTIVE: To compare single-limb heel-rise performance and foot-ankle kinematics between persons with stage 2 adult-acquired flatfoot deformity (AAFD) and healthy controls.

BACKGROUND: The inability to perform a single-limb heel rise is considered a positive functional diagnostic test for AAFD. However, which foot motions contribute to poor performance of this task are not known.

METHODS: Fifty individuals participated in this study, 20 with stage 2 AAFD (mean +/- SD age, 57.6 +/- 11.3 years), and 15 older participants (age, 56.8 +/- 5.3 years) and 15 younger participants (age, 22.2 +/- 2.4 years) without AAFD as control …

Concurrent Validity Of Accelerations Measured Using A Tri-Axial Inertial Measurement Unit While Walking On Firm, Compliant, And Uneven Surfaces, Michael H. Cole, Wolbert Van Den Hoorn, Justin K. Kavanagh, Steven Morrison, Paul W. Hodges, James E. Smeathers, Graham K. Kerr

Rehabilitation Sciences Faculty Publications

Although accelerometers are extensively used for assessing gait, limited research has evaluated the concurrent validity of these devices on less predictable walking surfaces or the comparability of different methods used for gravitational acceleration compensation. This study evaluated the concurrent validity of trunk accelerations derived from a tri-axial inertial measurement unit while walking on firm, compliant and uneven surfaces and contrasted two methods used to remove gravitational accelerations; i) subtraction of the best linear fit from the data (detrending); and ii) use of orientation information (quaternions) from the inertial measurement unit. Twelve older and twelve younger adults walked at their preferred …

Taking Physical Activity To The Streets: The Popularity Of Ciclovia And Open Streets Initiatives In The Us, J. Aaron Hipp

Brown School Faculty Publications

As a way to reduce chronic diseases associated with increasingly sedentary lifestyles, the Centers for Disease Control and Prevention advocates community-wide initiatives promoting physical activity. One such initiative gaining popularity in the US is the Ciclovía, or Open Streets initiative, where city streets are opened to residents for physical activity and closed to motorized traffic.1 Open Streets gained international prominence in Bogota, Colombia, and are viewed by policy makers and health and community advocates as being beneficial to social, environmental, and community health.2 The interest in initiatives is demonstrated by the increase in the number of events within and across …

Effectiveness Of Three Different Walking Prescription Durations On Total Physical Activity In Normal- And Overweight Women, Yves Schutz, Dac Nguyen, Nuala Byrne, Andrew Hills

Nuala Byrne

Objective: While there is a dose-response relationship between physical activity (PA) and health benefit, little is known about the effectiveness of different PA prescriptions on total daily PA. Aim: To test, under real-life conditions and using an objective, non-invasive measurement technique (accelerometry), the effect of prescribing additional physical activity (walking only) of different durations (30, 60 and 90 min/day) on compliance (to the activity prescribed) and compensation (to total daily PA). Participants in each group were prescribed 5 sessions of walking per week over 4 weeks. Methods: 55 normal-weight and overweight women (mean BMI 25 +/- 5 kg/m(2), height 165 …

Active Transportation In Dayton, Ohio: A Case Study, Danielle P. Tong

Master of Public Health Program Student Publications

Introduction: The purpose of this case study was to describe Dayton, Ohio’s process for implementing an active transportation initiative and suggests ways in which it might be improved. Methods: This paper compares the strategies used in Dayton, Ohio to the 5Ps of the Active Living by Design’s Community Action Model, and compares them with the strategies of three communities described in the literature. Results: The City of Dayton fully initiated two of the 5Ps but neglected the other Ps. Some interview respondents attribute this to a lack of staffing within the City of Dayton. Dayton’s leadership for active transport comes …

Examining Mediators To Physical Activity As A Link To Interventional Efforts Aimed At Increasing Activity Levels And Improving Physical Functioning In Older Adults, Christopher Dondzila

Theses and Dissertations

The number of older adults living in the United States is growing at an increasingly rapid rate, and is host to a high prevalence of chronic diseases and physical impairments. Physical activity and exercise have been shown to be beneficial in impacting such conditions, yet the majority of older adults remain inactive. The purpose of this dissertation was to employ a sequence of studies to investigate mediators to physical activity, leading to an intervention to increase activity and promote health.

The purpose of Project VOICE was to examine whether awareness and utilization of community resources to promote physical activity and …

Preventing Paediatric Obesity; Recommendations From A Community-Based Qualitative Investigation, Patricia Tucker, Jennifer Irwin, L. Sangster Bouck, Meizi He, G. Pollett

Trish Tucker

Childhood obesity is on the rise, and interventions targeted at pre-school-aged children are essential for the primary prevention of this disease. Physical activity programming and decreasing screen viewing may be advantageous ways to reduce the early onset of obesity. Parents' perceptions regarding effective tools and programmes to target obesity are needed to develop an efficacious programme. Ten semi-structured focus groups were conducted for this qualitative study. Two experienced moderators facilitated all focus groups which were conducted in local day cares, workplaces and play groups, frequented by parents. All focus groups were audio-recorded and transcribed verbatim. Strategies to ensure trustworthiness of …

An Examination Of Walkability In The Las Vegas Metropolitan Area, Courtney Coughenour

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: The benefits to regular physical activity are well established. Walkability is one element of the built environment that has been correlated with increased levels of physical activity. The auto-centric design of Las Vegas Metropolitan area (LVMA) is unique in ways that may influence walkability. The purpose of this study was to determine which urban design characteristics are associated with walking and physical activity in moderate income neighborhoods in LVMA. Methods: The standard walkability measure developed by Frank et al. (2010) was used to calculate the walkability index of seven neighborhoods. Residents of the two most walkable and two least …

Intensive Goal-Directed Treatments In Enriched Environments Augments Patient Outcomes Post-Stroke, Blake A. Kandah, Michael A. Klonowski, Ryan M. Pelo, Nicole M. Williams, Raquel V. Santiago, Christopher K. Thompson, Kristan A. Leech, Carey L. Holleran, Abigail L. Leddy, T. George Hornby

GW Research Days 2013

Objective: Previous research indicates that patients post-stroke, average 400-800 steps within physical therapy sessions and demonstrate heart rate values of 24-35% of HR Max. This dosage and intensity is inadequate to promote neuroplastic changes and maximize recovery. The goal of this study was to quantify and examine the amount of high-intensity stepping practice that was delivered within an Acute Inpatient Rehabilitation (AIR) setting for individuals with sub-acute stroke.

Methods: 14 patients with a diagnosis of sub-acute stroke were admitted to AIR. Standardized outcomes included the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), the Berg Balance Scale (BBS) and the …

The Walking Index For Spinal Cord Injury (Wisci/Wisci Ii): Nature, Metric Properties, Use And Misuse., J. F. Ditunno, Jr, P. L. Ditunno, G. Scivoletto, M. Patrick, M. Dijkers, H. Barbeau, A. S. Burns, R. J. Marino, M. Schmidt-Read

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Literature review.

OBJECTIVE: To critically review all publications/internet sites that have described/used the Walking Index for Spinal Cord Injury (WISCI II), as a measure of impairment of walking function after spinal cord injury (SCI), in order to identify its psychometric properties, clarify its nature, specify misuse and incorporate the findings in an updated guide.

METHOD: A systematic literature search was done of Ovid MEDLINE, CINAHL, PsychINFO, Cochrane Central Register of Controlled Trials, Scopus and electronic sites using key words: WISCI or WISCI II, SCI, paraplegia/ tetraplegia/ quadriplegia and ambulation/gait/walking. Among 1235 citations retrieved, 154 relevant articles/sites were identified, …

Effect Of A Tai Chi Chuan Slow Walking Intervention On Balance And Mobility In Individuals With Multiple Sclerosis, Julianna Averill

Masters Theses 1911 - February 2014

In people with Multiple Sclerosis (MS) balance impairments may lead to increased falls and mobility loss. In quiet stance, people with MS display greater postural sway than healthy controls. Tai Chi is a Chinese martial art that has decreased the risk of falling in frail elderly individuals (Wolf et al., 1996). The purpose of this study was to determine if a three week Tai Chi intervention would improve postural stability in people with MS. Seven participants (6F/1M, age 48.5 ± 10.8 years, height 1.66 ± 0.08m, mass 68.6 ± 19.8kg) attended nine one hour training sessions to practice two types …