Correlation Enhanced Distribution Adaptation For Prediction Of Fall Risk, Ziqi Guo, Teresa Wu, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon

Physical Therapy Faculty Articles and Research

With technological advancements in diagnostic imaging, smart sensing, and wearables, a multitude of heterogeneous sources or modalities are available to proactively monitor the health of the elderly. Due to the increasing risks of falls among older adults, an early diagnosis tool is crucial to prevent future falls. However, during the early stage of diagnosis, there is often limited or no labeled data (expert-confirmed diagnostic information) available in the target domain (new cohort) to determine the proper treatment for older adults. Instead, there are multiple related but non-identical domain data with labels from the existing cohort or different institutions. Integrating different …

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sanchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Tricia M. Kesar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sánchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Trisha M. Keshar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Integrating Glenohumeral Range Of Motion With Dynamic Postural Control For Early Detection Of Elbow Injury Risk In Collegiate Baseball Pitchers: A Preliminary Prospective Case Series, Brent A. Harper, Luke J. Bailey, Mikayla N. Jones, Joseph Bradley

Physical Therapy Faculty Articles and Research

Introduction: Medial elbow ulnar collateral ligament (UCL) injuries are common in baseball with increased surgical incidence in pitchers. There is no consensus on which modifiable injury risk metrics or performance screening tools to use to identify at risk collegiate baseball pitchers. Current literature on UCL injury risk has focused on local passive glenohumeral rotational motion with limited forays into more global movement patterns. The aim of this study was to assess possible relationships involving UCL injuries and modifiable local and global motor control performance risk factors. Material and Methods: An observational single cohort case series involving 15 collegiate …

Novice Inter-Rater Reliability On The Selective Functional Movement Assessment (Sfma) After A 4-Hour Training Session, Brent Harper, Adrian Aron

Physical Therapy Faculty Articles and Research

Background

The Selective Functional Movement Assessment (SFMA) is a whole-body movement classification system that identifies non-optimal movement performance requiring further assessment. There needs to be more evidence specifying the training time required to obtain SFMA reliability for entry-level health care practitioners.

Purpose

The primary intent of this study was to determine SFMA inter-rater reliability between two third-year physical therapy students following an in-person three-hour training and one-hour follow-up training with a certified SFMA physical therapist. The secondary purpose was to compare rater scores of the composite criterion 50-point checklist and rater categorization using the top-tier movements in real-time assessments of …

Lifelong Fitness In Ambulatory Children And Adolescents With Cerebral Palsy I: Key Ingredients For Bone And Muscle Health, Noelle G. Moreau, Kathleen M. Friel, Robyn K. Fuchs, Sudarshan Dayanidhi, Theresa Sukal-Moulton, Marybeth Grant-Beuttler, Mark D. Peterson, Richard D. Stevenson, Susan V. Duff

Physical Therapy Faculty Articles and Research

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with …

Lifelong Fitness In Ambulatory Children And Adolescents With Cerebral Palsy Ii: Influencing The Trajectory, Susan V. Duff, Justine D. Kimbel, Marybeth Grant-Beuttler, Theresa Sukal-Moulton, Noelle G. Moreau, Kathleen M. Friel

Physical Therapy Faculty Articles and Research

Physical activity of at least moderate intensity in all children contributes to higher levels of physical and psychological health. While essential, children with cerebral palsy (CP) often lack the physical capacity, resources, and knowledge to engage in physical activity at a sufficient intensity to optimize health and well-being. Low levels of physical activity place them at risk for declining fitness and health, contributing to a sedentary lifestyle. From this perspective, we describe a framework to foster a lifelong trajectory of fitness in ambulatory children with CP (GMFCS I–III) as they progress into adolescence and adulthood, implemented in conjunction with a …

Habitual Exercise Evokes Fast And Persistent Adaptation During Split-Belt Walking, Sasha A. Brinkerhoff, Natalia Sánchez, Jaimie A. Roper

Physical Therapy Faculty Articles and Research

Changing movement patterns in response to environmental perturbations is a critical aspect of gait and is related to reducing the energetic cost of the movement. Exercise improves energetic capacity for submaximal exercise and may affect how people adapt movement to reach an energetic minimum. The purpose of this study was to determine whether self-reported exercise behavior influences gait adaptation in young adults. Young adults who met the optimal volume of exercise according to the Physical Activity Guidelines for Americans (MOVE; n = 19) and young adults who did not meet the optimal volume of exercise (notMOVE; n = 13) walked …

Identifying The Neural Correlates Of Anticipatory Postural Control: A Novel Fmri Paradigm, Jo Armour Smith, Rongwen Tain, Kelli G. Sharp, Laura M. Glynn, Linda R. Van Dillen, Korinne Henslee, Jesse V. Jacobs, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Altered postural control in the trunk/hip musculature is a characteristic of multiple neurological and musculoskeletal conditions. Previously it was not possible to determine if altered cortical and subcortical sensorimotor brain activation underlies impairments in postural control. This study used a novel fMRI-compatible paradigm to identify the brain activation associated with postural control in the trunk and hip musculature. BOLD fMRI imaging was conducted as participants performed two versions of a lower limb task involving lifting the left leg to touch the foot to a target. For the supported leg raise (SLR) the leg is raised from the knee while the …

Dense & Attention Convolutional Neural Networks For Toe Walking Recognition, Junde Chen, Rahul Soangra, Marybeth Grant-Beuttler, Y. A. Nanehkaran, Yuxin Wen

Physical Therapy Faculty Articles and Research

Idiopathic toe walking (ITW) is a gait disorder where children’s initial contacts show limited or no heel touch during the gait cycle. Toe walking can lead to poor balance, increased risk of falling or tripping, leg pain, and stunted growth in children. Early detection and identification can facilitate targeted interventions for children diagnosed with ITW. This study proposes a new one-dimensional (1D) Dense & Attention convolutional network architecture, which is termed as the DANet, to detect idiopathic toe walking. The dense block is integrated into the network to maximize information transfer and avoid missed features. Further, the attention modules are …

Comparison Of Clinical And Biomechanical Characteristics Between Individuals With Lower Limb Amputation With And Without Lower Back Pain: A Systematic Review And Meta-Analysis, Szu-Ping Lee, Shawn Farrokhi, Jenny A. Kent, Jason Ciccotelli, Lung-Chang Chien, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Background

Lower back pain is a debilitating condition common to individuals with lower limb amputation. It is unclear what risk factors contribute to the development of back pain. This study systematically reviewed and analyzed the available evidence regarding the clinical and biomechanical differences between individuals with amputation, with and without lower back pain.

Methods

A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL databases in November 2020 and repeated in June 2021 and June 2022. Studies were included if they reported comparisons of demographic, anthropometric, biomechanical, and other clinical variables between participants with and without LBP. …

Reliability And Validity Of Inertial Sensor Assisted Reaction Time Measurement Tools Among Healthy Young Adults, Brent Harper, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

The assessment of movement reaction time (RT) as a sideline assessment is a valuable biomarker for mild TBI or concussion. However, such assessments require controlled laboratory environments, which may not be feasible for sideline testing during a game. Body-worn wearable devices are advantageous as being cost-effective, easy to don and use, wirelessly transmit data, and ensure unhindered movement performance. This study aimed to develop a Drop-stick Test System (DTS) with a wireless inertial sensor and confirm its reliability for different standing conditions (Foam versus No Foam) and task types (Single versus Dual), and postures (Standing versus sitting). Fourteen healthy young …

Bruce Protocol Test Affects Postural Stability In Healthy Young Adults, Andreas Germanos, Tessa Heiberg, Annie Jeon, Emi Heisterkamp, Hao Giang, Jessica Cota, Laura Corona, Thomas Loi, Vincent Bovino, Shayce Cordero, Sunny Kim, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

Maintaining balance is key in avoiding falls and injury. However, little is known on how increased cardiac activity may affect postural stability. This study investigated if increase in cardiac activity to 85% maximal heart rate (HR) when exercising with standard Bruce Protocol Test (BPT) influence postural sway. Ten young adults were tested for three postural stances, quiet bilateral standing with i) eyes open, ii) eyes closed, and iii) tandem stance, before and after performing the BPT. Resting Heart Rate (HR) and HR variability along with standard postural sway parameters like sway velocity, sway area, turn index, and power frequency in …

Classifying Toe Walking Gait Patterns Among Children Diagnosed With Idiopathic Toe Walking Using Wearable Sensors And Machine Learning Algorithms, Rahul Soangra, Yuxin Wen, Hualin Yang, Marybeth Grant-Beuttler

Physical Therapy Faculty Articles and Research

Idiopathic toe walking (ITW) is a gait abnormality in which children’s toes touch at initial contact and demonstrate limited or no heel contact throughout the gait cycle. Toe walking results in poor balance, increased risk of falling, and developmental delays among children. Identifying toe walking steps during walking can facilitate targeted intervention among children diagnosed with ITW. With recent advances in wearable sensing, communication technologies, and machine learning, new avenues of managing toe walking behavior among children are feasible. In this study, we investigate the capabilities of Machine Learning (ML) algorithms in identifying initial foot contact (heel strike versus toe …

General Variability Leads To Specific Adaptation Toward Energy Optimal Policies, Sabrina J. Abram, Katherine L. Poggensee, Natalia Sánchez, Surabhi N. Simha, James M. Finley, Steven H. Collins, J. Maxwell Donelan

Physical Therapy Faculty Articles and Research

Our nervous systems can learn optimal control policies in response to changes to our bodies, tasks, and movement contexts. For example, humans can learn to adapt their control policy in walking contexts where the energy-optimal policy is shifted along variables such as step frequency or step width. However, it is unclear how the nervous system determines which ways to adapt its control policy. Here, we asked how human participants explore through variations in their control policy to identify more optimal policies in new contexts. We created new contexts using exoskeletons that apply assistive torques to each ankle at each walking …

Quantifying Intra- And Interlimb Use During Unimanual And Bimanual Tasks In Persons With Hemiparesis Post-Stroke, Susan V. Duff, Aaron Miller, Lori Quinn, Gregory Youdan Jr., Lauri Bishop, Heather Ruthrauff, Eric Wade

Physical Therapy Faculty Articles and Research

Background

Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited.

Objective

To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance.

Methods

Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into …

Test-Retest Reliability Of Postural Control Assessment On Biodex Biosway™, Daniel Miner, Brent A. Harper, Stephen M. Glass, Brooke Martin, Molly Polizotto, S. Montana Hearl, Ellen Turner

Physical Therapy Faculty Articles and Research

Background. Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols. Purpose. The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an …

Do People With Low Back Pain Walk Differently? A Systematic Review And Meta-Analysis, Jo Armour Smith, Heidi Stabbert, Jennifer J. Bagwell, Hsiang-Ling Teng, Vernie Wade, Szu-Ping Lee

Physical Therapy Faculty Articles and Research

Background

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.

Methods

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included …

Visualization-Driven Time-Series Extraction From Wearable Systems Can Facilitate Differentiation Of Passive Adl Characteristics Among Stroke And Healthy Older Adults, Joby John, Rahul Soangra

Physical Therapy Faculty Articles and Research

Wearable technologies allow the measurement of unhindered activities of daily living (ADL) among patients who had a stroke in their natural settings. However, methods to extract meaningful information from large multi-day datasets are limited. This study investigated new visualization-driven time-series extraction methods for distinguishing activities from stroke and healthy adults. Fourteen stroke and fourteen healthy adults wore a wearable sensor at the L5/S1 position for three consecutive days and collected accelerometer data passively in the participant’s naturalistic environment. Data from visualization facilitated selecting information-rich time series, which resulted in classification accuracy of 97.3% using recurrent neural networks (RNNs). Individuals with …

Kinematic Analysis Of 360° Turning In Stroke Survivors Using Wearable Motion Sensors, Masoud Abdollahi, Pranav Madhav Kuber, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Background: A stroke often bequeaths surviving patients with impaired neuromusculoskeletal systems subjecting them to increased risk of injury (e.g., due to falls) even during activities of daily living. The risk of injuries to such individuals can be related to alterations in their movement. Using inertial sensors to record the digital biomarkers during turning could reveal the relevant turning alterations. Objectives: In this study, movement alterations in stroke survivors (SS) were studied and compared to healthy individuals (HI) in the entire turning task due to its requirement of synergistic application of multiple bodily systems. Methods: The motion of 28 participants (14 …

Kinematic Assessment Of Turning And Walking Tasks Among Stroke Survivors By Employing Wearable Sensors And Pressure Platform, Masoud Abdollahi, Pranav Madhav Kuber, Christopher Hoang, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Stroke survivors often experience reduced movement capabilities due to alterations in their neuromusculoskeletal systems. Modern sensor technologies and motion analyses can facilitate the determination of these changes. Our work aims to assess the potential of using wearable motion sensors to analyze the movement of stroke survivors and identifying the affected functions. We recruited 10 participants (5 stroke survivors, 5 healthy individuals) and conducted a controlled laboratory evaluation for two of the most common daily activities: turning and walking. Among the extracted kinematic parameters, range of trunk and sacrum lateral bending in turning were significantly larger in stroke survivors (p-value<0.02). However, no statistical difference in mean angular velocity and range of motion for trunk/sacrum/shank flexion-extension were obtained in the turning task. Our results also indicated that during walking, while there was no difference in swing time, double support portion of gait among the stroke group was significantly larger (p-value = 0.001). Outcomes of this investigation may help in designing new rehabilitation programs for stroke and other neurological disorders and/or in improving the efficacy of such programs.Clinical Relevance— This study may provide a better insight on the detailed functional differences between stroke survivors and healthy individuals which in turn could be used to develop a more efficient rehabilitation program for stroke community.

Prediction Of Fall Risk Among Community-Dwelling Older Adults Using A Wearable System, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon, Teresa Wu, Christopher W. Frames, Raven Weaver, Karen A. Roberto

Physical Therapy Faculty Articles and Research

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined …

Self-Paced Treadmills Do Not Allow For Valid Observation Of Linear And Nonlinear Gait Variability Outcomes In Patients With Parkinson’S Disease, Maryam Rohafza, Rahul Soangra, Jo Armour Smith, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background

Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods

Thirteen patients with Parkinson’s Disease …

Effects Of Rucksack Military Accessory On Gait Dynamic Stability, Seong H. Moon, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Various factors are responsible for injuries that occur in the U.S. Army soldiers. In particular, rucksack load carriage equipment influences the stability of the lower extremities and possibly affects gait balance. The objective of this investigation was to assess the gait and local dynamic stability of the lower extremity of five subjects as they performed a simulated rucksack march on a treadmill. The Motek Gait Real-time Interactive Laboratory (GRAIL) was utilized to replicate the environment of the rucksack march. The first walking trial was without a rucksack and the second set was executed with the All-Purpose Lightweight Individual Carrying Equipment …

Different Biomechanical Variables Explain Within-Subjects Versus Between-Subjects Variance In Step Length Asymmetry Post-Stroke, Natalia Sánchez, Nicolas Schweighofer, James M. Finley

Physical Therapy Faculty Articles and Research

Step length asymmetry (SLA) is common in most stroke survivors. Several studies have shown that factors such as paretic propulsion can explain between-subjects differences in SLA. However, whether the factors that account for between-subjects variance in SLA are consistent with those that account for within subjects, stride-by-stride variance in SLA has not been determined. SLA direction is heterogeneous, and different impairments likely contribute to differences in SLA direction. Here, we identified common predictors between-subjects that explain within-subjects variance in SLA using sparse partial least squares regression (sPLSR). We determined whether the SLA predictors differ based on SLA direction and whether …

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

Lost In Translation: Simple Steps In Experimental Design Of Neurorehabilitation-Based Research Interventions To Promote Motor Recovery Post-Stroke, Natalia Sánchez, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of researchbased interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on …

Foot Contact Dynamics And Fall Risk Among Children Diagnosed With Idiopathic Toe Walking, Rahul Soangra, Michael Shiraishi, Richard Beuttler, Michelle Gwerder, Louanne Boyd, Venkateswaran Muthukumar, Mohamed Trabia, Afshin Aminian, Marybeth Grant-Beuttler

Physical Therapy Faculty Articles and Research

Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and agematched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated …

Reliability Of A Barre-Mounted Dynamometer-Stabilizing Device In Measuring Dance-Specific Muscle Performance, Melissa Strzelinksi, Lori Thein Brody, Jo Armour Smith, Shaw Bronner

Physical Therapy Faculty Articles and Research

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. …

Effects Of Auditory Cueing On Cadence And Gait Pattern, Andrew Carballo, Matthew Chang, Brian Hirmiz, Nicolette Lambright, Vivian Lee, Marla Lewis, Martin Nguyen, Matthew Gothong, Rahul Soangra

Physical Therapy Faculty Articles and Research

A large portion of the population participate in gait rehabilitation, especially those with conditions such as increased fall risk such as stroke, or Parkinson’s Disease. Some studies have shown that auditory cues help improve gait and reduce fall risk, but relationship with gait patterns is missing. In this study, eight participants walked at their preferred cadence and at increased and reduced cadence by 20%. We found that step length and step width were not significantly different in all walking conditions. Decreased cadence resulted in an increase of swing time, stance time, stride time, and stance to swing ratio, and a …