Medicine and Health Sciences Commons^™

Patient And Therapist Perceptions Of Respiratory Functioning Due To Spinal Cord Injury: Implications For Music Therapists, A'Marie Dotson

Theses and Dissertations--Music

Decreased respiratory functioning is a common symptom of spinal cord injury (SCI) and can impact individuals’ personal, professional, and social lives. In spite of this, researchers have not explored the use of music in the lives of individuals with SCIs or music’s role in their healthcare professionals’ treatment plans to improve respiratory functioning. The purpose of this qualitative study was to better understand how decreased respiratory functioning affects individuals with SCIs and healthcare professionals through a multiple case study design. Participants were two individuals with SCIs and three healthcare professionals (physical therapist, recreational therapist, and music therapist) who worked with …

Neurophysiological And Psychological Characteristics Of Individuals With History Of Lateral Ankle Sprain, Katherine Bain

Theses and Dissertations--Rehabilitation Sciences

Lateral ankle sprain (LAS) is among the most common lower limb musculoskeletal injuries impacting both the general and sport populations. Even more problematic is that approximately 70% of individuals who sustain an LAS develop residual deficits. Of that subgroup, roughly 40% develop chronic ankle instability (CAI). Chronic ankle instability is a clinical diagnosis defined by the presence of ongoing impairments following the initial LAS which may include perceived instability, pain, mechanical instability, and episodes of giving way during physical activity. Not all who sustain multiple ankle sprains or experience residual deficits fit the clinical diagnosis criteria for CAI; yet may …

Cognitive-Motor Interactions In Gait And Postural Control And Cortical Network Neurocorrelates, Nathan Morelli

Theses and Dissertations--Rehabilitation Sciences

The ability to mitigate performance decrements during the concurrent completion of cognitive and motor tasks (i.e., dual task (DT)) deteriorates in patients with mild Traumatic Brain Injury (mTBI). It is theorized that the long-term sequelae of mTBI are due to the return to full activity prior to neurophysiologic healing. To mitigate the negative outcomes associated with mTBIs, translational clinical research of neurophysiologic recovery is of paramount importance for both athletic and non-athletic populations. Despite the well-known health consequences, clinical decisions regarding neurophysiologic recovery and return to activity remain problematic for clinicians. Return to activity decisions are currently based on normalization …

Evaluation Of The Effectiveness Of A Pain Neuroscience Education Curriculum For Patients Who Experience Chronic Musculoskeletal Pain With Concurrent Opioid Dependence, Nicole D. Windsor

Theses and Dissertations--Rehabilitation Sciences

Background: Chronic musculoskeletal pain (CMP) is estimated to affect over 100 million adults annually and is targeted as an instigator of opioid dependence (OpD). Opioid medications are often the first response for patients suffering from CMP, but over 10 million people annually admit to misusing opioids. With the opioid epidemic, the healthcare system now has a population of patients who experience CMP with concurrent OpD. This persistent problem creates a perfect storm of fear of movement, low self-efficacy, and physical dysfunction. A critical component to chronic pain management is understanding how patients view their pain experience. Education may be one …

Changing The Perspective In Management Of A Progressive Neurological Disorder: Developing Interventions To Target Multifactorial Components Of Parkinson’S Disease With Emphasis On Improving Clinical Meaningful Outcomes, Jordana Christine Lockwich

Theses and Dissertations--Rehabilitation Sciences

Neurological disorders are currently the leading source of disability in the United States with Parkinson’s disease (PD) having the fastest growing incidence rate (Abate et al., 2017). PD is the second most common degenerative disease in older adults above 60 years old (Tysnes & Storstein, 2017) and epidemiology reports predict that the number of PD cases has doubled to 6 million since 1990 (Dorsey, Sherer, et al., 2018) It is estimated that PD prevalence will continue to rise with a projected 60,000 new cases in the United States by 2030 (Dorsey, Elbaz, et al., 2018) and has the potential to …

Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm

DNP Projects

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project …

Effect Of Blood Flow Restriction Training On Functional And Self-Reported Outcomes In Female Runners With Patellofemoral Pain, Lauren Nicole Erickson

Theses and Dissertations--Rehabilitation Sciences

Background: Patellofemoral pain (PFP) is the leading cause of lower extremity injury in female runners, significantly limiting running ability and becoming chronic in nearly 50% of the cases. This condition, which presents as pain around (peripatellar) or behind (retropatellar) the patella, is associated with significant weakness of the quadriceps and gluteal musculature, as well as altered movements mechanics. The challenge for clinicians is designing an effective treatment program to reduce pain and improve function without causing symptoms to flare. Blood flow restriction training (BFRT) is a relatively new training method within rehabilitation that involves placing a pressurized cuff to the …

The Influence Of Physical Health, Emotional Health, And Socioeconomic Factors On The Musculoskeletal Pain Experience In Patients Attending A Pro Bono Physical Therapy Clinic, Garrett Naze

Theses and Dissertations--Rehabilitation Sciences

Non-communicable, chronic diseases are highly prevalent in the United States, reducing the quality of life for those affected and contributing to the majority of the nation’s healthcare expenditure. These conditions include, among others, cardiovascular disease, diabetes, and musculoskeletal disease. Musculoskeletal disease is particularly of interest for the field of physical therapy as the vast majority of patients seeking care in the outpatient setting present with musculoskeletal pain complaints, resulting in limitations in function, participation, and quality of life for the patient.

The factors influencing health outcomes are diverse and include a person’s physical environment, social and economic factors, access to …

Development Of A Field Expedient Screening Tool For The Coach To Identify Musculoskeletal Risk Factors In Baseball Players, Kyle Andrew Matsel

Theses and Dissertations--Rehabilitation Sciences

Identification of musculoskeletal (MSK) injury risk factors in baseball players can be challenging particularly for youth and high school coaches. Many baseball coaches lack a sports medicine and/or strength and conditioning staff to assist with injury prevention initiatives. Given the extensive responsibilities in managing the team and preparing the players for athletic competition, little time remains to focus on injury prevention and arm care programs. Furthermore, assessment, diagnosis, and management of MSK impairments is outside the scope of practice and expertise of baseball coaches. However, educating and empowering the coach to efficiently screen their players for potentially injury producing MSK …

Clinical And Neurophysiological Effects Of Dry Needling On Individuals With Chronic Ankle Instability, Jennifer Mullins

Theses and Dissertations--Rehabilitation Sciences

Ankle sprains are generally considered innocuous injuries; however, as many as 74% of patients will develop chronic symptoms. 1-3 Chronic ankle instability (CAI) is defined by a history of ankle sprain accompanied by ongoing bouts of giving way, residual ankle sprain symptoms, and a decrease in patient-perceived function. As understanding of sensorimotor deficits in individuals with CAI have advanced, treatment strategies have evolved to include a robust focus on balance training to mitigate dynamic and static postural control impairments exhibited in individuals with CAI. A problem arises as these improvements have not been conclusively linked to a decrease in CAI. …

Psychosocial Predictors Of Chronic Pain And Pain-Related Disability 12 Months After Lower Extremity Fracture, Joshua Judson Van Wyngaarden

Theses and Dissertations--Rehabilitation Sciences

Over 700,000 lower extremity fractures occur each year with a large portion of these patients developing adverse long-term pain and disability outcomes. Current literature indicates that 39% to 62.7% of all patients report continued pain long after traumatic lower extremity fracture. Concurrent physical limitations and reduced quality of life are common, with nearly one-third of all patients reporting pain-related disability seven years after limb threatening trauma, and approximately 50% of these patients having limitations in functional mobility and activities of daily living at long-term follow-up. These poor long-term injury-related pain and disability outcomes are alarming and require further action to …

An Evaluation Of Postural Control And Balance After Anterior Cruciate Ligament Reconstruction, Kathryn Lucas

Theses and Dissertations--Rehabilitation Sciences

Over 100,000 anterior cruciate ligament reconstructions (ACLR) occur annually in the United States, with one in four individuals sustaining a second injury within the first two years after reconstruction. Due to the proprioceptive nature of the anterior cruciate ligament, the lack of regaining postural control and balance are likely large contributors to the rate of secondary injuries after ACLR. Recent literature has identified cerebral changes after anterior cruciate ligament injury and surgery, likely due to altered sensation and feedback loops. However, no study thus far has investigated the neurological feedback loops that may place this group at higher risk of …

Effects Of Load Carriage On Shoulder Neuromuscular Functions And Recovery, Muataz R. Almaddah

Theses and Dissertations--Rehabilitation Sciences

Load carriage is a primary source for injury occurrence among military personnel and recreational hikers affecting all body areas. The shoulder ranks as the second or third most common site of injuries among military personnel. Many studies report that elevations in self-reported fatigue, soreness, and discomfort in the shoulders accompany the load carriage. Almost 50% of military personnel experienced a load carriage injury during the first episode of training, and 75% of those injured suffered a second injury during their career. The goal of this research project is to investigate the components associated with load carriage shoulder symptoms to determine …

Influences Of Functional And Psychological Factors On Biomechanics Following An Anterior Cruciate Ligament (Acl) Reconstruction, Chelsey Roe

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to return to sport (RTS) test batteries following primary anterior cruciate ligament reconstruction (ACLR) (Aim 1) and define recovery in athletes from 4-9 months after ACLR across three domains: 1) psychological recovery and biomechanics (Aim 2), 2) rehabilitation quantity and biomechanics (Aim 3), and 3) functional performance and biomechanics (Aim 4). Ultimately, the results of this research would quantify recovery following ACLR in athletes with a desire to RTS and identify objective criteria throughout rehabilitation prior to RTS.

Participants: Twenty-two post-ACLR athletes 17 females, 8 males, …

Clinical Measurements Of The Posterior Shoulder Endurance Test (Pset), Neil A. Evans

Theses and Dissertations--Rehabilitation Sciences

Of the intrinsic factors responsible for non-traumatic shoulder pain, muscular endurance is often not measured by rehabilitation professionals due to the lack of available shoulder endurance measures. Measurement properties of the PSET have not been adequately assessed in previous studies. The purpose of this dissertation was to develop the clinical measurement properties of the Posterior Shoulder Endurance Test (PSET) so that it might be used as a clinical measure of shoulder muscular endurance.

Electromyography (EMG) offers the ability to identify which muscles in the posterior shoulder girdle are fatiguing during the PSET. Surface EMG of upper trapezius (UT), middle trapezius …

Knee Joint Loading Following Anterior Cruciate Ligament Reconstruction: Link To Patient Reported Outcomes And A Novel Method To Monitor With Wearable Sensors, Alex Spencer

Theses and Dissertations--Kinesiology and Health Promotion

Recovery from anterior cruciate ligament reconstruction (ACLR) commonly results in undesirable physical and patient-reported outcomes (PROs). Identification of modifiable factors such as knee contact force (KCF) early in rehabilitation that can improve these outcomes is important due to the rapid decrease in function, quality of life, and joint health in this population. Additionally, if noninvasive measurement of KCFs outside of a traditional laboratory were possible, clinicians could optimize patient treatment with personalized care. Therefore, there are two primary aims to this thesis: 1) quantify the link between KCF and PROs which measure pain, ability to perform activities of daily living, …

A Brain-Computer Interface For Closed-Loop Sensory Stimulation During Motor Training In Patients With Tetraplegia, Sarah Helen Thomas

Theses and Dissertations--Biomedical Engineering

Normal movement execution requires proper coupling of motor and sensory activation. An increasing body of literature supports the idea that incorporation of sensory stimulation into motor rehabilitation practices increases its effectiveness. Paired associative stimulation (PAS) studies, in which afferent and efferent pathways are activated in tandem, have brought attention to the importance of well-timed stimulation rather than non-associative (i.e., open-loop) activation. In patients with tetraplegia resulting from spinal cord injury (SCI), varying degrees of upper limb function may remain and could be harnessed for rehabilitation. Incorporating associative sensory stimulation coupled with self-paced motor training would be a means for supplementing …

Connecting The Pieces: How Low Back Pain Alters Lower Extremity Biomechanics And Shock Attenuation In Active Individuals, Alexa Johnson

Theses and Dissertations--Rehabilitation Sciences

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with …

Prevalence Of Sports-Related Stress Urinary Incontinence In The Female Collegiate Athlete, Stacey Pagorek

Theses and Dissertations--Rehabilitation Sciences

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.

Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in …

Changes In Muscle Size, Quality And Power Are Related To Physical Function In Patients With Critical Illness, Kirby Mayer

Theses and Dissertations--Rehabilitation Sciences

Patients admitted to intensive care unit (ICU) are known to develop significant impairments in physical function. Patients with critical illness suffer up to 30% reductions in muscle size within the first ten days of admission to the ICU. Muscle strength testing, Medical Research Council-sum score, is current gold-standard to diagnosis ICU-acquired weakness and predicts risk of mortality and long-term physical function. Muscle power different from muscle strength in that it accounts for velocity of movement, is potentially a better independent predictor of function that has not been studied in this population. In addition, we hypothesize that muscle size and quality …

Leadership Development In Physical Therapy: Moving Toward A Community Of Transformative Practitioners, Kerry Cronin Mallini

Theses and Dissertations--Educational Leadership Studies

Physical therapy as an emerging profession is committed to establishing its identity and solidifying its role as a leader in health care. With expertise in human movement, wellness, and disease prevention, physical therapists possess invaluable knowledge and skill to influence public health and enhance patient recovery without increasing cost. Physical therapists have the opportunity to transform the delivery of public health services to meet current and future needs. A major challenge, however, is a dearth of leadership development in preparation programs. Because most physical therapists have not received formal education or explicit training in leadership, a problem of practice exists. …

Mobility Boost: A Quality Improvement Project To Bridge A Gap In Care For Hospitalized Adults, Audrey M. Johnson

Theses and Dissertations--Rehabilitation Sciences

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early …

Tissues And Trauma: Pain Neuroscience Education For Veterans With Post-Traumatic Stress And Low Back Pain, Timothy Mark Benedict

Theses and Dissertations--Rehabilitation Sciences

Low back pain (LBP) is the top reason for Soldiers to seek medical care and one of the top reasons to be medically discharged. Mental health problems and psychosocial stressors have been increasing in Soldiers and are also top causes for medical discharge. Dysregulated stress has contributed to many Soldiers and Veterans to develop chronic LBP as well as mental health disorders like post-traumatic stress disorder (PTSD). Research suggests that psychosocial characteristics, as opposed to physical factors or tissue health, contribute to chronic pain the most. Focusing entirely on tissues for individuals seeking care for LBP can increase disability and …

The Assessment And Utilization Of Patients’ Self-Efficacy For Exercise During Rehabilitation, Kelsey J. Picha

Theses and Dissertations--Rehabilitation Sciences

Patient adherence to in-clinic rehabilitation is between 30-70% and even lower for home exercise programs (HEPs). Barriers to patient adherence have been identified and include but are not limited to anxiety, depression, lack of positive feedback, lack of social support, lack of time, low levels of physical activity at baseline, pain during exercise, and low self-efficacy. As clinicians prescribing rehabilitation may not be able to influence all of the identified barriers, they may positively influence others. Self-efficacy, or an individual’s belief in his/her ability to successfully complete a task, is a patient barrier that may be addressed by a clinician …

Muscle Synergy During A Single Leg Standing Test In Ambulatory Children With Cerebral Palsy, Brennan L. Smith

Theses and Dissertations--Kinesiology and Health Promotion

INTRODUCTION: Cerebral Palsy (CP) is a sensorimotor disorder characterized by dysfunctional motor coordination, balance problems, and loss of selective motor control. Motor coordination exhibited as co-contraction, has been subjectively quantified using gait analysis, but recent studies have begun to objectively analyze the amount of co-contraction by collecting electromyography (EMG) data. Center of pressure excursion (COPE) measurements collected during a single leg standing test (SLST) have shown to be more valid measurements of balance in populations with motor disabilities than a SLST alone. A recent study has correlated increased COPE velocity with a lower fall risk as determined by reported fall …

Using Foot Pressure Analysis To Predict Reoccurrence Of Deformity For Children With Unilateral Clubfoot, Juanita Jean Wallace

Theses and Dissertations--Kinesiology and Health Promotion

Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and …

A Systems Approach To The Problem Of Falls In Old Age, Patrick A. Dillon

Theses and Dissertations--Gerontology

The problem of falls in old age is enormously costly and disruptive for the older individual, others, and society, and its severity is likely to intensify as our population ages. This dissertation takes a systems-oriented approach toward the falls problem and is presented in two parts. The first part critically develops a new approach to the problem of falls. The second part describes an empirical study that applies this new approach in a pragmatic manner.

Conventional fall prevention strategies employ a reductionist approach to the problem of falls. This approach is questioned because it corresponds poorly to the holistic nature …

Age-Related Differences In The Lumbopelvic Kinematics During The Trunk Motions In The Anatomical Planes, Milad Vazirian

Theses and Dissertations--Biomedical Engineering

Management and control of the low back pain as an important health problem in the industrial societies necessitates to investigate how the risk of this disease is affected by aging. Since the abnormalities of the lumbopelvic kinematics are related to the existence or risk of low back injuries, the objective of this dissertation was set to find the age-related differences in lumbopelvic kinematics when performing basic trunk motions reaching to range of motion in different anatomical planes.

A cross-sectional study was designed where sixty asymptomatic individuals between 20–70 years old with no confounding health condition, no current or previous highly …

The Effect Of One-On-One Intervention In Athletes With Multiple Risk Factors For Injury, Kathryn Schwartzkopf-Phifer

Theses and Dissertations--Rehabilitation Sciences

Background: Lower extremity (LE) musculoskeletal injuries in soccer players are extremely common. These injuries can result in many days of lost time in competition, severely impacting players and their respective teams. Implementation of group injury prevention programs has gained popularity due to time and cost-effectiveness. Though participation in group injury prevention programs has been successful at reducing injuries, programs often target a single injury and all players do not benefit from participation. Players with a greater number of risk factors are most likely to sustain an injury, and unfortunately, less likely to benefit from a group injury prevention program. …

Longitudinal Adaptations In Muscle Strength, Functional Performance, Gait Biomechanics, And Patient-Reported Function After Unilateral Total Knee Arthroplasty, Paul W. Kline

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to impairments after total knee arthroplasty (TKA) (Aim 1) and define recovery between 3 and 6 months after TKA across four domains: 1) hip and knee muscle performance, 2) functional performance, 3) patient-reported function, and 4) biomechanics of walking and stair descent (Aim 2). Additionally, this project sought to explore the relationships between each domain (Aim 3) and establish predictive models to allow clinicians to use clinical measures to predict future gait biomechanics in patients after TKA (Aim 4). Ultimately, the results of this research would …