Physical Therapy Commons^™

Early Post-Immobilization Pain At Rest, Movement Evoked Pain, And Their Ratio As Potential Predictors Of Pain And Disability At Six- And 12-Months After Distal Radius Fracture, Maryam Farzad, Joy C. Mcdermid, Saurabh Mehta, Ruby Grewal, Erfan Shafiee

Physical Therapy Faculty Research

Background: Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury.

Methods: This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain …

Neuromuscular Response To A Single Session Of Whole-Body Vibration In Children With Cerebral Palsy: A Pilot Study, Huaqing (Virginia) Liang, Gena Henderson, Jianhua Wu

Physical Therapy Faculty Research

Background Whole-body vibration (WBV) is a relative new intervention paradigm that could reduce spasticity and improve motor function in children with cerebral palsy (CP). We investigated neuromuscular response to a single session of side-alternating WBV with different amplitudes in children with CP.

Methods Ten children with spastic CP aged 7–17 years at GMFCS level I-III participated in this pilot study. Participants received two sessions of side-alternating WBV with the same frequency (20 Hz) but different amplitudes (low-amplitude: 1 mm and high-amplitude: 2 mm). Each session included six sets of 90 s of WBV and 90 s of rest. Before and …

A Systematic Review Of The Effects Of Blood Flow Restriction Training On Quadriceps Muscle Atrophy And Circumference Post Acl Reconstruction, Derek Charles, Ryan White, Caleb Reyes, Drew Palmer

Physical Therapy Faculty Research

Background:

ACL reconstruction often results in an extended period of muscle atrophy and weakness. Blood flow restriction (BFR) training is a technique that has been shown to decrease muscle atrophy in a variety of populations.

Purpose:

The purpose of this systematic review was to analyze the research presented on the effect of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction.

Study Design:

Systematic Review

Methods:

Articles were reviewed using the databases Google Scholar, PubMed, and EBSCO. Keywords included blood flow restriction training, ACL reconstruction, and quadriceps.

Inclusion criteria included:

English language, peer-reviewed journals; randomized control …

Effect Of Predictability Of The Magnitude Of A Perturbation On Anticipatory And Compensatory Postural Adjustments, Tippawan Kaewmanee, Huaqing (Virginia) Liang, Alexander S. Aruin

Physical Therapy Faculty Research

Balance maintenance in response to a perturbation could be affected by the predictability of the magnitude of the body disturbance. We investigated anticipatory (APAs) and compensatory (CPAs) postural adjustments in response to perturbations of predictable and unpredictable magnitudes. Twenty young adults received series of perturbations of small or large magnitudes the order of which was varied. Electromyographic activity of six leg and trunk muscles and displacements of the center-of-pressure (COP) were recorded. The muscle onset time, integrals of muscle activity, and COP displacements in the anterior–posterior direction were analyzed during the APA and CPA phases. The results indicated that when …

Older Adults Retain The Ability To Predict External Perturbations Using Auditory Cues Only, Huaqing Liang, Tippawan Kaewmanee, Alexander S. Aruin

Physical Therapy Faculty Research

To maintain balance and prevent destabilization, humans utilize anticipatory postural adjustments (APAs) prior to the postural perturbations based on predictions and past experience. APAs involve the activation and inhibition of the trunk and leg muscles and a shift of the center-of-pressure (COP) position. The generation of APAs majorly relies on the availability and accuracy of visual information. However, our previous work showed that young adults could rely on an auditory cue only to generate APAs for an external perturbation similar to that when the visual information was available. Older adults generally have diminished APAs and consequently diminished postural control when …

Young Adults Can Learn To Predict Unexpected Posterior Perturbations Using An Auditory Cue, Huaqing Liang, Tippawan Kaewmanee, Alexander S. Aruin

Physical Therapy Faculty Research

To reduce the effect of an expected postural perturbation, central nervous system uses anticipatory postural adjustments (APAs), which include the activation and inhibition of the postural muscles and a slight shift of the center-of-pressure (COP) position. The generation of APAs majorly relies on the availability of visual information, and is learned through past experience. Hence, such protective mechanism to maintain balance is not implemented when perturbation comes from one’s back unexpectedly. Our previous work showed that young adults could rely on an auditory cue only to generate APAs for a front perturbation similar to that when vision was available. So …

A Literature Review And Clinical Commentary On The Development Of Iliotibial Band Syndrome In Runners, Derek Charles, Clay Rodgers

Physical Therapy Faculty Research

Background and Purpose:

Iliotibial Band Syndrome (ITBS) is the second leading cause of pain in runners and there are a number of theories related to its etiology. Multiple theories exist for the etiology of ITBS related symptoms including anterior-posterior friction of the IT band on the lateral femoral condyle during knee flexion and extension activities, compression of a layer of fat near the IT band distal attachment, and inflammation of the IT band bursa. The purpose of this literature review and clinical commentary was to explore the potential factors that contribute to ITBS development in runners.

Description of Topic with …

The Role Of An Auditory Cue In Generating Anticipatory Postural Adjustments In Response To An External Perturbation, Huaqing Liang, Tippawan Kaewmanee, Alexander S. Aruin

Physical Therapy Faculty Research

Anticipatory postural adjustments (APAs) are usually generated to minimize the potential postural disturbance induced by predictable external perturbations. Visual information about a perturbation is important for the generation of APAs, but whether people can rely on auditory information to generate APAs is unknown. The aim of this study was to investigate the role of an auditory cue in generating APAs when visual information is not available. Fifteen young adults participated in the study. They received external perturbations a) with visual information but no auditory information available, b) without neither visual nor auditory information, c) with both visual and auditory information …

Knee Joint Kinematics Of The Pendulum Test In Children With And Without Down Syndrome, Diego M. Ferreira, Huaqing Liang, Jianhan Wua

Physical Therapy Faculty Research

Background: The Wartenberg pendulum test is a common clinical test that is used to measure stiffness about the knee in persons with and without disabilities such as cerebral palsy and Down syndrome (DS). Adults and adolescents with DS show fewer number of swing cycles and a lower relaxation index than healthy controls. However, it is not clear if children with DS show a similar trend compared to typically developing (TD) children.

Research question: Was the knee joint kinematics different between children with and without DS during the pendulum test?

Methods: Thirteen children with DS and 13 TD children participated in …

Effects Of Ankle Angular Position And Standing Surface On Postural Control Of Upright Stance, Fawaz A. Alwadani, Huaqing Liang, Alexander S. Aruin

Physical Therapy Faculty Research

The purpose of the study was to investigate the effects of ankle angular position and standing surface type on static upright balance. Ten young adults stood on a force platform or on a firm wedge that induced 15° of either dorsiflexion or plantarflexion. In addition, a piece of foam was placed on top of the force platform and on the wedge. The center of pressure distance and velocity in the anteroposterior and mediolateral directions were calculated. Significantly larger magnitudes in most of the investigated variables were seen while standing with ankles in the dorsiflexion when compared with standing with the …

Improvement In Overground Walking After Treadmill-Based Gait Training In A Child With Agenesis Of The Corpus Callosum, Gena Henderson, Matthew Beerse, Huaqing Liang, Diego Ferreira, Jianhua Wu

Physical Therapy Faculty Research

Background: Agenesis of the corpus callosum (ACC) is a rare congenital brain defect that produces a wide variety of cognitive and motor impairments. Literature regarding the response of pediatric populations with ACC to physical rehabilitation is scarce. Treadmill-based gait training (TT) has been shown to improve walking ability in some pediatric populations but has not been investigated in children with ACC.

Objective: The purpose of this study was to investigate the effect of a novel treadmill intervention paradigm on the gait parameters of a child with ACC.

Design: A single-participant design with 2 phases was used.

Methods: The settings were …

Use Of Clinical Test Clusters Versus Advanced Imaging Studies In The Management Of Patients With A Suspected Slap Tear, Richard C. Clark, Chasiti C. Chandler, Andrew C. Fuqua, Kelly N. Glymph, Grayson C. Lambert, Katherine J. Rigney

Physical Therapy Faculty Research

Background and Purpose

The Magnetic Resonance Arthrogram (MRA) has served as the gold standard for identifying patients with possible Superior Labrum Anterior-Posterior (SLAP) lesions and are often required by orthopaedic surgeons prior to clinical evaluation. However, as the literature shows MRA sensitivity as 0.65-0.98, and specificity between 0.80-1.00, there is still room for misinterpretation of the imaging study, and potential mismanagement of a patient who may or may not exhibit a true SLAP lesion. It is proposed that by grouping a series of clinical special tests it may be possible to develop greater sensitivity in identifying a SLAP lesion, resulting …

Variability Of Spatiotemporal Gait Parameters In Children With And Without Down Syndrome During Treadmill Walking, Matthew Beerse, Gena Henderson, Huaqing Liang, Toyin Ajisafe, Jianhua Wu

Physical Therapy Faculty Research

Methods: Thirteen children with DS (aged 7–10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

Results and significance: Across all conditions, the DS group took shorter and wider steps than the TD group, but …

Transitioning From The Level Surface To Stairs In Children With And Without Down Syndrome: Motor Strategy And Anticipatory Locomotor Adjustments, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Background: Children with Down syndrome (DS) show underdeveloped motor strategy and anticipatory locomotor adjustments (ALA) before crossing an obstacle. Stairs presents another important setting to study environment navigation and motor adaptation. Inclusion of external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question: How do stair height and external ankle load affect motor strategy and ALA in 5-to-11-year-old children with typical development (TD) and with DS when approaching the stairs?

Methods: Fourteen children with DS and 14 age- and sex-matched children with TD participated in the study. They …

An Electromyography Study Of Muscular Endurance During The Posterior Shoulder Endurance Test, Neil A. Evans, Emily Dressler, Tim Uhl

Physical Therapy Faculty Research

The primary purpose was to determine if there is a difference between the median frequency slopes of 5 posterior shoulder muscles during the initial portion of the Posterior Shoulder Endurance Test (PSET) at the 90⁰ and 135⁰ shoulder abduction positions.

Fifty-five healthy volunteers (31 females) participated. The median frequency of the posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and infraspinatus (INF) was measured during the PSET at 90⁰ and 135⁰ of shoulder abduction. External torque of 13±1 Nm was used for females and 21±1 Nm for males. A fixed effect multi-variable regression model was used …

Locomotor Adjustments During Stair Ascent In Children With Down Syndrome: Comparison Between Walking And Crawling Strategies, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Stair negotiation provides an important yet different paradigm to study environment navigation. As one has constantly move himself up while adjusting step length and foot placement due to the stair constraints, this paradigm is ideal to study motor strategy and adaptation in children with and without disabilities. Down syndrome (DS) is the most common genetic condition and causes significant delays in motor and cognitive development. Children with DS show poor postural control and less efficient gait patterns. When negotiating obstacles, they often select a more conservative strategy (i.e. crawling instead of walking). This study aimed to examine motor strategy and …

Characterizing The Recovery Trajectories Of Knee Range Of Motion For One Year After Total Knee Replacement, Saurabh Mehta, Andrew Rigney, Kyle Webb, Jacob Wesney, Paul W. Stratford, Franklin D. Shuler, Ali Oliashirazi

Physical Therapy Faculty Research

DESIGN: Retrospective analysis of routinely collected clinical data.

OBJECTIVE: This study modeled the recovery in knee flexion and extension range of motion (ROM) over 1 year after total knee replacement (TKR).

BACKGROUND: Recovery after TKR has been characterized for self-reported pain and functional status. Literature describing target knee ROM at different follow-up periods after TKR is scarce.

METHODS: Data were extracted for patients who had undergone TKR at a tertiary care hospital at 2, 8, 12, 26, and 52 weeks after TKR. A linear mixed-effects growth model was constructed that investigated the following covariates age, sex, pre-TKR range, body mass …

Transitioning From Level Surface To Stairs In Children With And Without Down Syndrome: Locomotor Adjustments During Stair Ascent, Huaqing Liang, Xiang Ke, Jianjia Wu

Physical Therapy Faculty Research

Background: Children with Down syndrome (DS) often show underdeveloped motor ability and adaptation. Stair ascent is a common task to examine locomotor function and external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question: How do stair height and external ankle load affect locomotor adjustments in 5-to-11-year-old children with typical development (TD) and with DS during stair ascent?

Methods: Fourteen children with DS and 14 age- and sex-matched children with TD participated in this study. They walked along a 5-m walkway and ascended 3-step staircases of different heights …

Center Of Mass Control And Multi-Segment Coordination In Children During And After Whole-Body Vibration, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Maintaining upright posture under external perturbations requires the coordination between the nervous system and the musculoskeletal system, and it is a milestone of motor development in early childhood. Whole-body vibration (WBV) has acute effect on postural control and muscular activation during standing, resulting in an increased sway velocity and sway area of center-of-mass (COM), and the residual effect usually vanishes within 20 minutes after the vibration exposure. In quiet standing, a human body can be considered as a multi-segment linked system, and an uncontrolled manifold (UCM) approach has been used to examine how this multi-joint motor redundancy is utilized to …

Motor Strategy And Locomotor Adjustments In Children With And Without Down Syndrome While Negotiating Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down Syndrome (DS) often show impaired motor control, and walk with a slower speed and a shorter step length than typically developing (TD) children. When negotiating an obstacle, children with DS often stop for a longer duration, choose a more conservative crawling strategy and display a smaller toe clearance than their TD peers.

Effect Of Whole-Body Vibration On Center-Of-Mass Movement During Standing In Children And Young Adults, Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5min after 40-s WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5min after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.

Spatiotemporal Gait Pattern In Children With And Without Down Syndrome While Walking From Level Surface To Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down syndrome (DS) display a delayed motor development, and show clumsy and less coordinated gait pattern. Compared to typically developing children (TD), children with DS walk with a notably slower speed, a shorter stride length, a limited range of motion in ankle joint with increased plantar flexion, and reduced dorsal flexion throughout the gait cycle. When negotiating an obstacle, children with DS show shorter stride length and greater step length variability, and stop in front of the obstacle before stepping over it.

Effect Of Whole Body Vibration On Center Of Mass Movement In Children And Young Adults, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) has acute effects on postural control strategy. The degree of impact depends on the amplitude, frequency, and duration of WBV, and the difficult level of balance task as well as the reliability of sensory information to the individual [1, 2, 3]. Healthy young adults can return to the baseline level of postural sway for a simple balance task within 20 minutes after repeated exposure to WBV [4]. Little is known about the acute and residual effects of WBV on the center-of-mass (COM) movement after a single bout of WBV. This study aimed to understand the COM …

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 …

Psychometric Properties Of The Hindi Version Of The Disabilities Of Arm, Shoulder, And Hand: A Pilot Study, Saurabh Mehta, Ramesh Tiruttani, Manraj N. Kaur, Joy Macdermid, Rania Karim

Physical Therapy Faculty Research

Objectives. To culturally adapt and translate the Disabilities of Arm, Shoulder, and Hand questionnaire into Hindi (DASH-H) and assess its reliability, validity, and responsiveness in adult patients with shoulder tendonitis.

Study Design. Descriptive methodological research, using longitudinal design.

Setting. Outpatient clinic. Participants. 30 adult patients aged 53.3 ± 6.9 y with shoulder tendonitis.

Data Analyses. DASH-H, visual analogue scales for pain (VAS-P) and disability (VAS-D), and shoulder active range of motion (AROM) were assessed at baseline, 2-3 days later, and 4-5 weeks after baseline. Intraclass correlation coefficients (ICC) assessed test-retest reliability of these scales and responsiveness …

Differences In Symptoms Among Adults With Canal Versus Otolith Vestibular Dysfunction: A Preliminary Report, Lisa Farrell, Rose Marie Rine

Physical Therapy Faculty Research

Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory …

Home-Based Multidisciplinary Rehabilitation Following Hip Fracture Surgery: What Is The Evidence?, Kathleen Donohue, Richelle Hoevenaars, Jocelyn Mceachern, Erica Zeman, Saurabh Mehta

Physical Therapy Faculty Research

Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery.

Methods. Systematic review methodology suggested by Cochrane Collaboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided.

Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional …

Predicting Risk For Adverse Outcomes Following Distal Radius Fracture, Saurabh Mehta Phd

Physical Therapy Faculty Research

Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules or assessing the risk of these adverse outcomes following DRF.

The first manuscript outlines a theoretical framework (RACE - Reducing pain, Activating, Cognitive reshaping, Empowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.

The Patient-Rated Wrist Evaluation (PRWE) is a …

Proposal For A Clinic Based Model Of Physical Therapist Consultation In A Geriatric Outpatient Clinic, Rania Karim, Patricia A. Higgins, Thomas R. Hornick

Physical Therapy Faculty Research

Purpose: The purpose of this article is to describe the role of a certified geriatric physical therapist (PT) in a geriatric outpatient clinic.

Methods: This pilot study used a model in which a geriatric certified doctor of physical therapy (DPT) provided consultations one afternoon a week for patients in the Outpatient Geriatric Clinic at the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC). Data collection included reason for referral, DPT’s interventions, and clinicians’ and patients’ perceptions.

Results: Over 7 months, the DPT consulted on 25 male patients ranging from 65 to 91 years, with a mean age …