Medicine and Health Sciences Commons^™

Improving Interdisciplinary Communication To Improve Patient Satisfaction, Jennifer J. Barnes

Master's Projects and Capstones

The Clinical Nurse Leader project took place at a Magnet Hospital in Northern California. It involved the nursing staff on a 23-bed Post-Surgical Medical Surgical unit, as well as the therapists providing care to their diverse patient population. The goal was to improve interdisciplinary communication to decrease the frequency of missed or postponed therapy sessions. A review of literature revealed that this preventable issue could be the most significant factor resulting in an extended length of stay and affecting overall patient satisfaction. Project data was gathered from a variety of sources, including a unit assessment, shadowing therapists, interviews with key …

Effect Of Dual Tasking On Walking Over Even And Uneven Surfaces In Functionally Independent Community Older Adults, Olajide L. Kolawole

Seton Hall University Dissertations and Theses (ETDs)

While several studies have reported a decrement in performance by older adults while walking and concurrently performing a dual task on even surfaces, to date the effects of dual tasking while walking on uneven surfaces commonly found in the community has received less attention. Thus, we sought to test the hypothesis that an incremental decrement in gait parameters will be observed, when walking on an uneven versus an even surface and furthermore, that this decrement would be dependent upon the concurrent performance of a secondary cognitive and/or motor task in functionally independent-living-community older adults.

Dynamic Gait Index assessed the subject’s …

Leadership Styles Of Clinical Coordinators And Clinical Instructors In Physical Therapy Clinical Education, Allison Kellish

Seton Hall University Dissertations and Theses (ETDs)

The APTA has identified the roles of the CCCE and CI as leaders in physical therapy clinical education. In the literature there appears to be an absence of studies examining the CCCE and CI leadership style and its impact on the preparation for clinical instruction, extra effort, job satisfaction and effectiveness of quality clinical education. The purpose of this study was to examine the leadership styles of CIs and CCCEs and to discern if there was a correlation between CI’s and CCCE’s perceptions of leadership style and perceptions of leadership effectiveness based upon three leadership outcomes. The second purpose of …

Physical Therapy Non-Treatment Of The Acute Hospital Inpatient, Daniel Lee Young

UNLV Theses, Dissertations, Professional Papers, and Capstones

The detrimental effects of inactivity and mobility extend to the most ill and injured patients in the acute hospital setting. Facilitating the activity and exercise of these most critical patients often requires the skill and expertise of a physical therapist. When physical therapists are involved in the care of hospital inpatients they experience significant benefits; patients experience fewer secondary complications related to their primary illness or injury, they spend less time in critical care units and less time in the hospital overall, and when they leave they go to less restrictive environments and more comfortable care settings. These known benefits …

Psychometric Evaluation Of Self-Report Pain And Disability Measures For Elbow Disorders, Joshua Vincent

Electronic Thesis and Dissertation Repository

Elbow disorders are one of the commonest musculoskeletal problems with a prevalence of 9% in men and 8.1% in women. Patient centered care is the goal of current healthcare delivery models; but optimizing treatment outcome and clinical research is hampered by a lack of outcome measures. Since pain and disability resulting from elbow disorders are experienced differently across individuals, they are best captured by patient reported outcome measures (PROM).

PROMs like the Patient-rated Elbow Evaluation (PREE); American Shoulder and Elbow surgeons – Elbow form (pASES-e) have been developed for use in elbow disorders, but important questions remain about their measurement …

Effect Of 17Β Estradiol & Foot Strike Patterns On Physiological & Biomechanical Changes In Runners, Iman Akef Khowailed

Loma Linda University Electronic Theses, Dissertations & Projects

It is well established that female runners are at a significantly increased risk of incurring injuries when compared to their male counterparts. Gender-specific factors such as anatomical, hormonal, and altered neuromuscular activation patterns have been implicated as causative factors. An association have been observed between hormonal fluctuation and ACL injury risk indicating potentially hormonal effect on both passive and dynamic knee stabilizer.

A growing contingency believes that we were designed with all we need in our feet to be able to run with minimal shoes that mimic barefoot running striking pattern. Habitual barefoot runners tend to FFS, compared to habitually …

Stride Length-Speed Relationship During Body Weight Supported Running, Carmen Chona

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to determine if body weight support influences the stride length-speed relationship. Additionally, the purpose was to determine if impact characteristics of running are influenced by body weight support and speed. Subjects (n=10; 6 female, 4 male) volunteered to participate in this study. All subjects were injury free and were comfortable running on a treadmill for 30 minutes. Subjects ran on a lower body positive (LBPP, Alter-G, G-Trainer) treadmill for 4 conditions of body weight (100, 40, 30 and 20% of body weight) and 4 running speeds (100, 110, 120 and 130% of the preferred …

Mechanisms Of Isometric Exercise-Induced Hypoalgesia In Young And Older Adults, Kathy J. Lemley

Dissertations (1934 -)

Pain reduction following exercise (exercise-induced hypoalgesia; EIH) is well-established in young adults. Specific to isometric exercise, the greatest EIH follows low intensity contractions held for long duration. The EIH response of older adults is not known; and the mechanisms for EIH are unclear at any age. This dissertation aimed to address these unknowns through a series of three studies. In study one, repeatability of pressure pain reports (pain threshold and pain ratings) was assessed in healthy older adults, including the impact of psychological factors. Pain reports, measured before and after quiet rest, did not change following quiet rest. Higher state …

Corticospinal Integration In Healthy Humans, Amanda Asmar, Leandra Manfredini, Kerri Mclean, Christina Scannapieco

Dissertations, Theses, and Capstone Projects

Synchronized arrival of neuronal signals from the periphery and motor cortex has been associated with neuronal plasticity and motor learning. The main objective of this study was to examine neuronal interactions following excitation of descending motor axons from the primary motor cortex (M1) and spinal neuronal circuits via transcranial magnetic stimulation (TMS) and transcutaneous electric stimulation of the spine (tsESS) in 15 healthy humans while seated semiprone. TMS was delivered below or above the resting motor evoked potential (MEP) threshold, for the tibialis anterior (TA) muscle, while tsESS was delivered at the lowest stimulation intensity that evoked responses in most …

The Long-Term Effects Of Low Level Laser Therapy (Lllt) Combined With Complex Decongestive Therapy (Cdt) In The Treatment Of Breast Cancer Lymphedema: A Double-Blind, Randomized, Placebo-Controlled Study, Olivia Bramlett, Igor Daysudov, Toshi Odaira, Bethany Rodriguez

Dissertations, Theses, and Capstone Projects

Complex Decongestive Therapy (CDT), the gold standard for lymphedema treatment, fails to demonstrate long-term efficacy. The purpose of this study was to determine the long-term efficacy of low level laser therapy (LLLT) in reducing post-mastectomy lymphedema when used with CDT. The experimental group received LLLT and CDT (n = 7) while control group received sham laser and CDT (n = 7), twice a week for 4 to 8 weeks. Percent arm circumference difference between affected and unaffected limbs was collected over 18 months. Results revealed no statistical difference between both groups at all time periods: 1 (p = 0.902), 2 …

Cortical Modulation Of Spinal Reflexes In Healthy Humans, Caitlin Bedell, Joseph Capogrosso, Kristin Thomas, Charlotte Westmoreland

Dissertations, Theses, and Capstone Projects

Considerable evidence suggests that monosynaptic and polysynaptic spinal reflexes are prone to corticospinal inputs. The goal of this study was to establish the cortical modulation of monosynaptic and polysynaptic spinal reflexes in healthy humans. Cutaneomuscular responses were evoked following stimulation of the medial edge of the right foot with a 30 ms pulse train every 10 s via a bipolar electrode and recorded from the ipsilateral tibialis anterior (TA) muscle. Across subjects, medial edge foot stimulation was delivered at 1.2 to 1.5 times the response threshold. The soleus H-reflex was evoked and recorded via conventional methods. The effects of transcranial …

Comparing Nmes Stimulation Intensity At Various Lengths Of The Tibialis Anterior, Brent Brookbush, Maya Hakami, Jennifer Wolff, Amy Zelin

Dissertations, Theses, and Capstone Projects

The purpose of this study was to determine if placement of electrodes at various distances along the Tibialis Anterior muscle belly had a significant effect on the intensity of stimulation needed to evoke a contraction using neuromuscular electrical stimulation (NMES). Twenty subjects between the ages of 21-65 in good health and presented with no precautions to NMES were recruited from the CUNY Hunter College physical therapy department. Two reference lines were drawn on subjects’ legs, one outlining the tibial crest (L1), and another from the most lateral portion of the tibial plateau to the center of the lateral malleolus (L2). …

The Effect Of Tdcs On Cd-1 Mouse Behavior Post Induced Sensorimotor Cortex Injury, Michelle Gardella, Natalia Gozias, Kristina Laktionova, Tricia Roehrig

Dissertations, Theses, and Capstone Projects

The functional topography of the motor cortex has been shown to be modifiable by transcranial direct current stimulation (tDCS). tDCS works by directing electrical currents into the brain which induces alterations in neuroplastic cortical excitability. This experiment’s aim was to test the effect of tDCS on recovery of skilled locomotion, recovery of balance, and recovery of grip strength after bilateral electrolytic lesions to sensorimotor cortices in mice. Tests employed in this experiment included the ladder test, grip test, and a balance pole test. We were able to show that 4 days of tDCS post brain injury in mice produced improvements …

Comparison Of An Intermittent Vs. Continuous Walking Program In Persons With Multiple Sclerosis Using The 6 Minute Walk Test: A Randomized Crossover Pilot Study, Stefanie Dicarrado, Bridget Dungan, Elizabeth Huallpa, Jacob Potrzeba

Dissertations, Theses, and Capstone Projects

Background: Difficulty with gait is one of the most common complaints of persons with MS (pwMS) and can be due to many causes, including neurogenic fatigue. Neurogenic fatigue is one of the most common MS symptoms, and can prevent pwMS from walking longer distances, thus limiting their ability to improve gait endurance. Intermittent walking, a technique where persons take breaks during walking rather than walking continuously, may allow for pwMS to walk longer distances due to less accrual of fatigue.

Objectives: The purpose of this pilot study was to examine whether a program of intermittent walking will result in a …

Influences Of Motor Control Instruction And Taping On Center Of Pressure And Scapulothoracic Kinematics During Reaching For Individuals With Hemiparesis, Michelle De Guzman, Tatyana Farber, Anna Kochanova, Jonathan Lazarus

Dissertations, Theses, and Capstone Projects

Purpose: To determine if application of Kinesiotape™ was able to normalize the overall reaching motion by analyzing both surface electromyographic data and force platform feedback. Design: This study utilizes a case-control design.

Subjects: 5 control and 5 stroke survivors age >40 were recruited for this study through flyers at Burke Rehabilitation Hospital, White Plains, NY.

Methods: Surface EMG electrodes were applied to upper extremity (UE) and lower extremity (LE) muscles and an accelerometer placed on the reaching UE. Subjects stood on a force platform and reached towards a target at shoulder height. The task was repeated 5-7 times with right …

The Performance Of Dancers On The Lower Quadrant Y Balance Test, Heather Cole, Jinny Mcgivern, Anna Morejon, Tiffany Sudol

Dissertations, Theses, and Capstone Projects

The Lower Quadrant Y-Balance Test (YBT-LQ) is an evidence-based screening tool that measures one’s ability to maintain unilateral stance while reaching the contralateral leg in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions. The purpose of this study was to observe the performance of collegiate dancers on the YBT-LQ and compare it with that of other athletic populations from previously published studies. 39 healthy collegiate dance majors at the Purchase College Conservatory of Dance (ages 17-24 years; mean years of dance training 12.9 ± 3.9 years) participated in this study. Subjects stood on the central platform of the YBT-LQ …

Motor Imagery And Action Observation As An Alternative Gait Training Intervention For The Elderly, Matthew F. Cirelli, Brian Fettner, Lindita Ismaili, Danielle Jordan

Dissertations, Theses, and Capstone Projects

Motor imagery (MI) is the mental representation of movement without any body movement. Action observation (AO) is a non-physical method of training, in which the learner observes the action of another individual. Eighteen subjects between ages 60-80 were randomly assigned to 3 training groups, the MI, AO and motor training groups. All subjects were assessed and measured with the Expanded Timed-Get Up and Go (TUG) test and Figure-8-Walk (F8W) test. All three groups yielded a significant improvement in difference in total TUG time (<0.05). When individual aspects of the TUG were considered, the sit to stand component improved in the MI and Motor groups. The results of this study suggest that MI and AO can improve cadence and have an effect mirroring that of motor practice. If utilized properly, MI and AO may be indicated as a rehabilitation intervention adjunct to gait training, and potentially decrease the risk of falls in the elderly population.

Falls Prevention Training At New York Presbyterian Hospital: Does Education Regarding Fall Prevention Reduce Incidence Of Falls After Discharge To Home From An Acute Rehabilitation Facility?, Yuning Chiu, Michelle Frager, Hyunseok Lee, Solange Wong

Dissertations, Theses, and Capstone Projects

The objective of this study was to determine the compared effectiveness of different instruction types for fall prevention training in an inpatient rehabilitation setting based on 6-month falls incidence. This study included 89 English-speaking patients aged 18-90 who participated in a fall prevention training program at New York Presbyterian Hospital’s inpatient rehabilitation center. Patients were divided into two class types, a group or an individual class. Both classes were subdivided into with and without a caregiver. A 10-Meter Walk Test, the Montreal Cognitive Assessment (MoCA), and admission and discharge Functional Independence Measure (FIM™) scores were recorded for baseline comparisons among …

Research Components In Curriculum Of Doctor Of Physical Therapy Programs, Stephen Ingrassia, Gary Mulligan, Roman Tverdovskiy, Andy Zhu

Dissertations, Theses, and Capstone Projects

PURPOSE: The purpose of the study is to determine the current Doctor of Physical Therapy program curriculum, as it applies to research classes and research projects. We investigated the current research requirements of various DPT programs nationwide to determine DPT graduates’ preparedness to conduct research post-graduation.

METHODS: Participants of the current study were recent DPT college graduates selected from DPT programs across the United States. Subjects were asked to participate in a brief online survey questionnaire in reference to their DPT program research curriculum.

RESULTS: A total of 215 DPT programs contacted, out of which 39 schools were able to …

The Effects Of Morning Versus Evening Stretching Exercises In Hamstrings Flexibility Gains, Camron Einerman, Emily Eleff, Ana Ilijeska, Aliza Zinberg

Dissertations, Theses, and Capstone Projects

Many human physiological functions, including muscle flexibility, exhibit a pattern over a 24-hour period, known as circadian rhythm. Muscle flexibility and its circadian rhythm have been researched, though much more information is needed, especially regarding the hamstring muscle group. The object of this study was to determine if stretching at different times of the day results in differences in hamstring flexibility. Since muscles and joints are most flexible at night, greater ranges of motion should be available, allowing for a greater degree of stretching to take place. We hypothesize that when utilizing the optimal type, duration, and frequency of stretch, …

Low-Cost Strider For Guatemala, Nicole Catherine Cooper, Gonzalo Hernandez, Jared W. Tower

Mechanical Engineering

The purpose of this project was to create a strider, a type of standing rehabilitation device, for children in developing countries who have trouble walking and supporting their full body weight. The project was initially brought to us by Cal Poly professor Brian Self, who had visited a clinic in San Marcos and determined that there were children there who had difficulties with walking and were a need for a rehabilitation device. The team discussed the problem with Dr. Self, Matt Robinson (a local San Luis Obispo prosthetist), and Cal Poly physics professor Pete Schwartz, all of whom had visited …

Screening For Torticollis And Plagiocephaly: The Role Of The Pediatrician, Lisa Ann Change-Yee Hwang

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to examine the effects of providing a standardized screening examination to a group of attending and resident physicians on the rate of torticollis and plagiocephaly diagnoses, the age at time of diagnosis, and the attitudes and practice patterns of the physicians. All subjects were given a standardized screening procedure by verbal instruction and handout, and also completed a pre-­‐ and post-­‐intervention questionnaire, which assessed the 􀂕􀂗􀂄􀂌􀂇􀂅􀂖􀂕􀇯􀀃 practice regarding the diagnosis and management of torticollis and plagiocephaly. A retrospective chart review was conducted to ascertain the changes in frequency and mean age of patients diagnosed …

Effect Of Monophasic Pulsed Current On The Treatment Of Plantar Fasciitis, Abdullah Alotaibi

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Plantar fasciitis (PF) is one of the most common soft tissue disorders that causes inferior heel and rear foot pain. Monophasic pulsed current (MPC) is a method of electrical stimulation (ES) clinically used to promote and accelerate wound healing processes. The aim of this prospective clinical trial was to investigate the effect of MPC and MPC coupled with plantar fascia specific stretching exercises (SE) in the treatment of PF. Methods: Forty four participants (twenty- two subjects were women; 22 were men with a mean age of 49 ± 10.6 years) diagnosed with PF were randomly allocated to receive MPC …

An Examination Between Swimming Ability, Gender, And Race- An Exploratory Investigation, Laynie E. Brown

Honors College Theses

One of the leading causes of unintentional death worldwide is drowning. From 2005-2009, an estimated 3, 107 people in the United States over the age of fifteen died from drowning (Peden, Oyegbite, & Ozanne-Smith, 2008). Research has found higher amounts of drowning deaths to be males than females and African-American than Caucasian (Saluja et al., 2005). However, no significant differences have been found in real or perceived water competency between gender or age groups (Moran et al., 2012). Thus, the purpose of this study was to examine ability to swim between gender, race, and school classification of college students. Quantitative …

Evidence For The Validity Of A Tool For Improved Pressure Ulcer Staging By The Non-Expert In The Live Patient, Janelle Borg, Carrie Johnston, Megan Lucke, Jordan Sinclair

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Pressure ulcers (PrUs) are a costly issue for the health care system. The utilization of a tool that increases the accuracy of PrU identification and staging may allow the health care team to better manage these wounds. The purpose of this study was to determine the validity of the NE1 Wound Assessment Tool (NE1 WAT) for increasing the wound assessment accuracy of novice nurses.

Subjects: A convenience sample of 11 novice nurses evaluated 11 wounds on eight patients at a 730 bed, hospital in Las Vegas, Nevada.

Methods: Subjects assessed 11 wounds on the patients independently. They …

Blended Pedagogy Pathophysiology Course: Effectiveness And Student Satisfaction, Betsy Botsford, Samantha Corn, Alanna Keenan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Evidence supports the effectiveness of computer-assisted instruction (CAI) versus a traditional face-to-face teaching model, but little is known regarding the effectiveness of a blended pedagogy. The purpose of this study is to determine the effectiveness of a blended learning format in a pathophysiology course for entry-level Doctorate of Physical Therapy (DPT) students, to evaluate their level of satisfaction of a podcast formatted course, and to observe changes in cohort performance over time.

Subjects: Five University of Nevada, Las Vegas (UNLV) DPT cohorts (n = 139) participated in the study. Some cohorts were taught in a traditional classroom …

Conceptual Framework Of A Novel Intervention To Improve Mobility In Children With Cerebral Palsy: The Successes And Challenges Of Implementing A Large Amplitude Movement Protocol, Tania Goodwill, Erin Jarrett, Beren Shah, Alanna Stockford

UNLV Theses, Dissertations, Professional Papers, and Capstones

While cerebral palsy remains one of the most common childhood disabilities, clinicians continue to face significant challenges developing effective treatment strategies for the widely variable presentation of motor function impairments associated with cerebral palsy. A large gap exists between current research based evidence and feasible clinical practice. The purpose of this paper is to introduce a novel intervention protocol, explore the theoretical framework behind the protocol and provide insight to clinicians about the successes and challenges faced while pilot testing the intervention. The novel intervention was adapted and implemented by researchers combining a large amplitude movement protocol with the well-researched …

Development Of A Tool To Assess Children’S Perceptions Of Their Own Balance (The Pediatric Balance Perception Battery): A Pilot Study, Jillian L. Beckett, Ashlee A. Harmon

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Psychosocial aspects of balance including self-perception, behaviors, and experiences, have been found to contribute to activity limitations and participation restrictions in adults. Clinical tools have been established to measure how adults feel about their own balance and the extent to which fear of falling and other related characteristics interfere with participation. There are no clinical tools presently available to explore these relationships and quantify the extent to which they interfere with activity and participation in children.

Purpose: To develop and test reliability and validity of a tool to evaluate balance self-perception in a pediatric population.

Participants: This sample of …

The Effect Of Trigger Point Dry Needling To The Multifidus Muscle On Resting And Contracted Thickness Of Transversus Abdominis In Healthy Subjects, Sarah Buckingham, Crystal Montoya, Daniella Morton

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Design: Randomized, blinded, controlled cross-over trial with each subject receiving both interventions within a seven-day span.

Objective: To determine if differences occurred in resting- or contraction-thickness of the transversus abdominis (TrA) muscle following application of trigger point dry needling (TPN) of the lumbar multifidus (MF) muscle in asymptomatic subjects.

Background: Recent studies have shown TPN decreases pain in areas throughout the body. The effect of dry needling the MF on low back pain (LBP), and its effect on core stabilization have not been investigated.

Methods: Forty-three healthy individuals who had not experienced LBP in the previous six months were …

Characteristics Of Subjects Who Avoid Activities And Participation Due To A Fear Of Falling In Parkinson’S Disease, Morgan Lopker, Molly Newman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The purpose of this study was to compare individuals with Parkinson’s disease (PD) exhibiting fear of falling avoidance behavior to those with no fear of falling avoidance behavior. Because avoidance behavior can have deleterious downstream consequences, it is important to determine what potentially mitigated physical and psychological factors are associated with it.

Subjects: Fifty-six community dwelling individuals (age=72.1 years, SD=9.6; males=42, females=14) with PD (Hoehn and Yahr Scale stage median=2.0, mode=3.0) were classified into two groups using the Fear of Falls Avoidance Behavior Questionnaire (FFABQ): avoiders (n=26, ≥20 FFABQ), and non-avoiders (n=30, <20 on the FFABQ).

Methods: Avoiders and non-avoiders were …