Physical Therapy Commons^™

The Immediate Cardiovascular Response To Joint Mobilization Of The Neck - A Randomized, Placebo-Controlled Trial In Pain-Free Adults, Emmanuel Yung, Cheongeun Oh, Michael Wong, Jason K. Grimes, Erica M. Barton, Muhammad I. Ali, David A. Cameron

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Background: Some normotensive patients can have a spike in resting systolic blood pressure (SBP) in response to acute neck pain. Applying the typical dosage of mobilization may potentially result in a sympatho-excitatory response, further increasing resting SBP. Therefore, there is a need to explore other dosage regimens that could result in a decrease in SBP.

Objectives: To compare the blood pressure (BP) and heart rate (HR) response of pain-free, normotensive adults when receiving unilateral posterior-to-anterior mobilization (PA) applied to the neck versus its corresponding placebo (PA-P).

Study design: Double-Blind, Randomized Clinical Trial.

Development Of The Clinical Teaching Effectiveness Questionnaire In The United States, Michelle E. Wormley, Wendy Romney, Anna E. Greer

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The purpose of this study was to develop a single valid measure for assessing clinical teaching effectiveness within the field of physical therapy. Pilot testing with CIs from both universities were purposively sampled to complete the questionnaire. The CI databases yielded 1,001 potential respondents, recruited via e-mail. The questionnaire and two follow-up reminders were sent. Respondents consented by clicking a link which redirected them to the SurveyMonkey® questionnaire. Two hundred five CIs completed the questionnaire, a 20.5% response rate. The 205 respondents were mostly female (68.4%) with an average age of 40.54 years (SD=10.22). CI experience was distributed as follows: …

Improving Completeness And Transparency Of Reporting In Clinical Trials Using The Template For Intervention Description And Replication (Tidier) Checklist Will Benefit The Physiotherapy Profession, Tiê Yamato, Chris Maher, Bruno Saragiotto, Anne Moseley, Tammy Hoffmann, Mark Elkins, Shannon Petersen, Sean P. Riley, Jean-Michel Brismée

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Incomplete reporting of interventions in physiotherapy studies is an important problem and The Journal of Manual and Manipulative Therapy endorses the use of the TIDieR checklist as a potential solution.

Health-Related Fitness For Children And Adults With Cerebral Palsy, Yvette Blanchard, Mary E. Gannotti, Wendy Romney

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Position Statement of ACSM Sports Medicine Basics 2016: Health-related physical fitness for persons with Cerebral Palsy should be developed in the same model as fitness for all of us: start early, be easily available and continue throughout the life span.

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

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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 …

Validity And Usability Of A Professional Association’S Web-Based Knowledge Translation Portal: American Physical Therapy Association’S Ptnow.Org, Judith E. Deutsch, Wendy Romney, Jan Reynolds, Tara Jo Manal

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Background: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. Methods: Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, "quick takes" with hyperlinks, and a portable two-page version) on …

Service Learning In Higher Education Exercise Science Programs, Wendy Bjerke

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Introduction: Service learning (SL) describes teaching methods that incorporate student service activities with specific learning objectives. SL has been applied to allied health higher education programs.

Purpose: To determine the applicability of SL to exercise science courses. SL data associated with an undergraduate course in exercise physiology serving a local fire department is examined.

Use Of The Term "Elderly", Dale Avers, Marybeth Brown, Kevin Chui, Rita A. Wong, Michelle M. Lusardi

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Using the term elderly for a person who is robust and independent as well as for a person who is frail and dependent says little about the individual.

Exploring The Five Phases Of Physical Therapist Professional Development Advanced By The Clinical Doctorate Degree, Salome V. Brooks

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The American Physical Therapy Association (APTA) 2020 strategic plan mandated that the clinical doctor of physical therapy degree (DPT) will be the minimum practice standard. The APTA failed to articulate a functional practice description recognizing the varying levels of preparation. The current literature validates the existence of a stepwise pattern of professional development in similarly evolving disciplines. Applied nursing research by Benner (Benner model of professional development, 2001) identified five stages of professional development and characteristics that were useful in the discipline's advancement. The purpose of the study was to apply the structure of the Benner Model to physical therapy …

Are Scores On The Ppt Useful In Determination Of Risk Of Future Falls In Individuals With Dementia?, Mary K. Farrell, Richard A. Rutt, Michelle M. Lusardi, Ann K. Williams

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Individuals with dementia or Alzheimer’s disease (AD), exhibit both a progressive decline in cognitive function and accumulating difficulty with physical function.¹ As cognitive impairment begins, individuals will initially demonstrate difficulties with short-term memory and with instrumental activities of daily living. As the dementia progresses, individuals will increasingly demonstrate difficulties with long-term memory, communication, and basic activities of daily living.

Getting To Know You: Key Clinical Concepts In Relationship-Based Interventions And Neurobehavioral Observations With Young Infants, Yvette Blanchard

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The newborn infant is a social organism, pre-disposed to interact with his caregiver and able to elicit the kind of caregiving necessary for successful adaptation. The earliest developmental task of the newborn is to organize behavior to be able to play an active role in influencing the caregiving environment and eliciting the kind of support needed for development. This task is accomplished through the attainment of self-regulation or balanced neurobehavioral functioning of the infant's autonomic, motor, state, and responsivity behavioral dimensions as described by Als.

White Paper: Walking Speed: The Sixth Vital Sign, Stacy Fritz, Michelle M. Lusardi

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Walking speed is "almost the perfect measure." This review summarizes the strong psychometric properties of walking speed and robust evidence for using this clinical measurement. Walking speed is easily measurable, clinically interpretable, and a potentially modifiable risk factor. For these reasons, using WS as the sixth vital sign is both pragmatic and essential.

Applying Classification And Decision Rule To Predict Outcome Of Whiplash In An Ambulatory Patient Recovering From Incomplete Spinal Cord Trauma, Emmanuel Yung

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It is not known whether a clinical prediction rule or a whiplash associated disorder (WAD) classification may be applied effectively in a second traumatic event to predict the outcome in a patient recovering from cord trauma. Therefore, the purpose of this case was to apply a decision rule and a whiplash classification to predict the outcome of a second traumatic event in a recovering incomplete spinal cord injured (SCI) patient who was ambulatory.

Branched-Chain Amino Acid Supplementation And Indicators Of Muscle Damage After Endurance Exercise, Beau K. Greer, John L. Woodard, Jim P. White, Eric M. Arguello, Emily M. Haymes

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The purpose of this study was to determine whether branched-chain amino acid (BCAA) supplementation attenuates indirect indicators of muscle damage during endurance exercise as compared with an isocaloric, carbohydrate (CHO) beverage or a noncaloric placebo (PLAC) beverage. Nine untrained men performed three 90-min cycling bouts at 55% VO_2peak. Subjects, blinded to beverage selection, ingested a total of 200 kcal of energy via the CHO or BCAA beverage before and at 60 min of exercise, or they drank the PLAC beverage. Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic leg-extension and -flexion torque, and muscle soreness were assessed before and …

Functional Rehabilitation: Managing Low Back Pain Through Activities-Of-Daily-Living Education, Timothy E. Speicher, R. Daniel Martin, Robert M. Desimone

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After trauma to the low back, a decrease in intervertebral joint stiffness can occur, which can lead to inability of the motor-control system to compensate for the tasks imposed on the tissues, resulting in spinal instability. Intervertebral joint stiffness can be thought of as a tightening of a corset around a spine segment, facilitated through coactivation of small and large spinal muscles. The motor-control system might be able to adapt initially with cocontractions of the intrinsic muscles, but an unbalanced demand between the small and large muscles can lead to muscle fatigue and poor task performance. The inability of the …

Top 10 Positional-Release Therapy Techniques To Break The Chain Of Pain, Part 1, Timothy E. Speicher, David O. Draper

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Positional-Release Therapy (PRT) is a treatment technique that is gaining popularity. The purpose of this two-part column is to briefly explain the theory and application of PRT. Then, we will present our top 10 list of what we think are the most commonly treated tender points by athletic therapists, five in Part 1 and five in Part 2, along with general tips, patient self-treatments, and adjunctive techniques.

PRT, originally termed strain–counterstrain, is a therapeutic technique that uses tender points (TPs) and a position of comfort (POC) to resolve the associated dysfunction. Essentially, PRT is the opposite of stretching.

PRT is …

Top-10 Positional-Release Therapy Techniques To Break The Chain Of Pain: Part 2, Timothy E. Speicher, David O. Draper

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Positional-Release Therapy (PRT) is advocated as an effective indirect therapeutic treatment for acute, subacute, and chronic somatic dysfunction. Initial investigations have shown PRT to significantly reduce low back and hip pain and improve hip strength. The effects of PRT are thought to occur from placing a patient’s tissues in a position of comfort for an extended period of time.

Clinically, the practice of PRT and its therapeutic benefits have an established history. What is lacking is research into the neural and physiologic mechanisms of the process by which PRT alleviates somatic dysfunction. It can be tempting to view the technique …

A Comparison Of Hip Versus Ankle Exercises In Elders And The Influence On Balance And Gait, Laura Z. Gras, Pamela Levangie, Mary (Tina) Goodwin-Segal, Deborah A. Lawrence

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Purpose: Reductions in hip and ankle strength and range of motion (ROM) in elderly subjects have been associated with decreased functional mobility and risk of falls. The purpose of this research was to determine if short duration hip or ankle interventions designed to increase ROM and strength could improve ROM and strength of those joints, as well as improve balance and gait outcomes. Methods: Well elderly volunteers recruited from retirement communities and a senior citizen center were randomly assigned to a hip or ankle intervention group. Both groups performed a home exercise program (HEP) of stretching 5 days a week …

Communication Apprehension And Interpersonal Skills In Physical Therapy Students : A Comparative Study Of Problem-Based Learning And Traditional Curricula, Beverly D. Fein

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Physical Therapy education has been challenged to prepare students to meet the increasing demands upon and changing needs of physical therapy practice in the evolving health delivery system. Today's practitioner needs strong interpersonal and collaborative skills for effective communication with patients, families, third party payers, community and other members of the health care team. The characteristics of problem-based learning (PBL) curricula appeared to offer greater potential for students to develop communication skills as compared to traditional curricula. Therefore, this study used available measures of communication apprehension and clinical performance of communication related behaviors to compare students educated in PBL curricula …

Thoracic Pain In A Collegiate Runner (Case Report), Gary P. Austin, W. T. Benesky

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This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the …

A Problem-Based Learning Approach To Facilitate Evidence-Based Practice In Entry-Level Health Professional Education, Michelle M. Lusardi, Pamela Levangie, Beverly D. Fein

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This article will provide an overview of the problem-based learning process, and an illustration of how problem-based learning can facilitate development of critical appraisal necessary for evidence-based practice. It will trace the development of problem-based learning as an educational methodology for entry-level health professional education. The information seeking and appraisal themes common to both problem-based learning and evidence-based practice will be examined, along with the roles and responsibilities of faculty and tutors who are part of problem-based learning courses or curricula. Examples of strategies for student assessment will be discussed, for both mastery of didactic content and for contribution to …

Effect Of Added Mass On Human Unipedal Hopping, Gary P. Austin, Gladys E. Garrett, David Tiberio

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Although hopping is considered a children's activity, it can be used to provide insight into the neuromuscular and biomechanical performance of adults. This study investigated whether mass added during unipedal hopping altered the vertical stiffness, hopping period, and angular kinematics of the lower exteremity of adults. Measures of two-dimensional kinematics and vertical force were made from 10 healthy men during hopping at a preferred period under three conditions: Body Mass, Body Mass +10%, and Body Mass +20%. Adding mass significantly increased hopping period and hip flexion without significantly affecting vertical stiffness, ankle dorsiflexion, or knee flexion. Overall, the findings agreed …

Effect Of Frequency On Human Unipedal Hopping, Gary P. Austin, David Tiberio, Gladys E. Garrett

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All mature forms of locomotion involve periods of unilateral stance. Unipedal hopping may provide useful information about the neuromuscular and biomechanical capabilities of a single lower extremity in adults. This study investigated whether hopping influenced vertical stiffness and lower extremity angular kinematics during human unipedal hopping. Vertical force and two-dimensional kinematics were measured in 10 healthy males hopping at three frequencies: preferred, +20%, and -20%. At +20%, compared to preferred, vertical stiffness increased 55% as hip flexion, knee flexion, and ankle dorsiflexion decreased, while at -20%, vertical stiffness decreased 39.4% as hip flexion, knee flexion, and ankle dorsiflexion increased. As …

Preparing Students For Ebp, Pamela Levangie

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Describes one particular approach to teaching evidence-based practice in physical therapy. At Sacred Heart University students begin course work that is foundational to preparing them for evidence-based practice. In the first semester of study, they take a Concepts in Measurement unit. During the second semester, I teach a semester-long Clinical Research course that focuses on understanding concepts of clinical research and on critical review of physical therapy literature. During the third and fourth semesters of study, when they are doing their clinical coursework, the emphasis is on the concepts of validity and reliability of the tools they use. The students …

Application And Interpretation Of Simple Odds Ratios In Physical Therapy-Related Research, Pamela Levangie

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Over the past several decades, physical therapists have demonstrated an increasing responsiveness to the profession's obligation to generate objective evidence for examination and intervention strategies employed in physical therapy practice. This trend is evident, not only in the increasing number of journals that are publishing physical therapy research, but in the growing sophistication of research design and analytic options used by investigators. At the same time, physical therapists are held increasingly accountable for adopting an evidence-based approach to practice. The result for many of us is a growing concern about our ability to interpret study findings. The ability to independently …

A Review Of The Legal Issues Surrounding Academic Dismissal, Beverly D. Fein

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Among the challenges faced by physical therapy educators is to determine whether students have made sufficient progress in the academic and/or clinical curriculum to merit continuance in the physical therapy program. At times, faculties must make the decision to dismiss a student due to failure to achieve the necessary performance criteria. These decisions are often clouded by fear of lawsuits and confusion about the responsibilities and prerogatives of professional judgments. This article traces the history of case law related to academic dismissal, examining a number of significant cases and the ramifications of these cases for professional programs. Key legal concepts …

Four Clinical Tests Of Sacroiliac Joint Dysfunction: The Association Of Test Results With Innominate Torsion Among Patients With And Without Low Back Pain, Pamela Levangie

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Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive …

Kinematic Analysis Of Obstacle Clearance During Locomotion, Gary P. Austin, Gladys E. Garrett, Richard W. Bohannon

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This study investigated the effect of obstacles of different heights on the locomotion of 15 healthy subjects. The following parameters were studied: (1) the distance of the toe and heel markers from the obstacle during toe-off and heel contact, respectively, (2) the minimum clearance distance of the toe and heel markers, and (3) the angular displacements and velocities of the hip, knee, and ankle. Results show significant differences in joint angular kinematics and clearance distances as obstacle height increased. The kinematic and distance differences exhibited both strong linear and non-linear trends. Toe-off distance and heel contact distance did not change …

Neurobehavioral And Neuromotor Long-Term Sequelae Of Prenatal Exposure To Cocaine And Other Drugs: An Unresolved Issue, Yvette Blanchard

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When the cocaine epidemic began, predictions were made that the children of cocaine users would demonstrate devastating negative developmental sequelae. In infants and young children prenatally exposed to cocaine most frequently the neurobehavioral and neuromotor systems have been studied. Although clinically described as irritable, difficult to console, and jittery as infants, research findings have not been able to clearly describe a pattern of long-term developmental sequelae. The mechanisms of action of drug exposure on developmental outcome have shown to be more complex than originally suspected. Many factors, other than the drug use, can influence developmental outcome. In most studies of …

Association Of Low Back Pain With Self-Reported Risk Factors Among Patients Seeking Physical Therapy Services, Pamela Levangie

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Background and Purpose. This study investigated the magnitude of association between low back pain (LBP) and self-reported factors thought to increase the risk of LBP. Subjects and Methods. Questionnaires were completed by 150 patients who were receiving physical therapy for LBP and by 138 patients who were being treated for other reasons. The solicited information was used to estimate odds ratios and 95% confidence intervals for the LBP-risk factor association. Results. Low back pain was positively associated with smoking status, pregnancy, industrial vibration exposure, and time spent in a car (odds ratios [is greater than or equal to] 2.21). Daily …