A Single-Center, Assessor-Blinded, Randomized Controlled Clinical Trial To Test The Safety And Efficacy Of A Novel Brain-Computer Interface Controlled Functional Electrical Stimulation (Bci-Fes) Intervention For Gait Rehabilitation In The Chronic Stroke Population, Piyashi Biswas, Lucy Dodakian, Po T. Wang, Christopher A. Johnson, Jill See, Vicky Chan, Cathy Chou, Wendy Lazouras, Alison L. Mckenzie, David J. Reinkensmeyer, Danh V. Nguyen, Steven C. Cramer, An H. Do, Zoran Nenadic

Physical Therapy Faculty Articles and Research

Background

In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise …

Evaluating Visual Dependence In Postural Stability Using Smartphone And Stroboscopic Glasses, Brent A. Harper, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

This study explores the efficacy of integrating stroboscopic glasses with smartphone-based applications to evaluate postural control, offering a cost-effective alternative to traditional forceplate technology. Athletes, particularly those with visual and visuo-oculomotor enhancements due to sports, often suffer from injuries that necessitate reliance on visual inputs for balance—conditions that can be simulated and studied using visual perturbation methods such as stroboscopic glasses. These glasses intermittently occlude vision, mimicking visual impairments that are crucial in assessing dependency on visual information for postural stability. Participants performed these tasks under three visual conditions: full vision, partial vision occlusion via stroboscopic glasses, and no vision …

Short-Term Benefits From Manual Therapy As An Adjunct Treatment For Persistent Postural-Perceptual Dizziness Symptoms: A Preliminary Prospective Case Series, Brent A. Harper, Larry Steinbeck

Physical Therapy Faculty Articles and Research

Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation^® method (FM^®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients …

Assessing Brain Processing Deficits Using Neuropsychological And Vision-Specific Tests For Concussion, Brent A. Harper, Rahul Soangra

Physical Therapy Faculty Articles and Research

Introduction: Since verbal memory and visual processing transpire within analogous cerebral regions, this study assessed (i) if a visual function can predict verbal memory performance. It also hypothesized whether neurocognitive (e.g., ImPACT) tests focusing on the Visual Memory and Cognitive Efficacy Index will predict Verbal Memory scores and (ii) if vision metrics and age can identify individuals with a history of concussion. Finally, it also hypothesized that King–Devick and near point of convergence scores alongside age considerations will identify candidates with a prior reported history of concussion. Materials and methods: This observational cohort assessed 25 collegiate ice hockey players prior …

The Feigned Annoyance And Frustration Test To Activate The Sympathoadrenal Medullary System, Ted W. Gehrig Iii, Lee S. Berk, Robert I. Dudley, Jo A. Smith, Lida Gharibvand, Everett B. Lohman Iii

Physical Therapy Faculty Articles and Research

When perceived as threatening, social interactions have been shown to trigger the sympathoadrenal medullary system as well as the hypothalamic-pituitary-adrenal axis resulting in a physiologic stress response. The allostatic load placed on human health and physiology in the context of acute and chronic stress can have profound health consequences. The purpose of this study was to develop a protocol for a lab-based stress stimulus using social-evaluative threat. While several valid, stress-stimulating protocols exist, we sought to develop one that triggered a physiologic response, did not require significant lab resources, and could be completed in around 10 min. We included 53 …

Testing The Reliability Of Optical Coherence Tomography To Measure Epidermal Thickness And Distinguish Volar And Nonvolar Skin, Molly E. Baumann, Nina Rossa Haddad, Alyssa Salazar, W. Lee Childers, Shawn Farrokhi, Neil B. Goldstein, Brad D. Henderson, Lisa Reider, Richard E. Thompson, Michael S. Valerio, Christopher L. Dearth, Luis A. Garza, Major Extremity Trauma Research Consortium (Metrc)

Physical Therapy Faculty Articles and Research

In persons with limb loss, prosthetic devices cause skin breakdown, largely because residual limb skin (nonvolar) is not intended to bear weight such as palmoplantar (volar) skin. Before evaluation of treatment efficacy to improve skin resiliency, efforts are needed to establish normative data and assess outcome metric reliability. The purpose of this study was to use optical coherence tomography to (i) characterize volar and nonvolar skin epidermal thickness and (ii) examine the reliability of optical coherence tomography. Four orientations of optical coherence tomography images were collected on 33 volunteers (6 with limb loss) at 2 time points, and the epidermis …

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 …

Running Biomechanics Differ During And After Pregnancy Compared To Females Who Have Never Been Pregnant, Jennifer J. Bagwell, Elizabeth Avila, Nicholas Reynolds, Jo Armour Smith, Kevin Valenzuela, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle.

Research question

Are perinatal running biomaechanics and muscle activation different compared to nulligravida females?

Methods

Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle …

Combining Static And Dynamic Myofascial Dry Cupping Therapy To Improve Local And Regional Symptoms In Individuals With Low Back Pain: A Case Series, Brent Harper, Alana Dudek, Julianne Williamson, Alex Siyufy, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Introduction

Chronic low back pain is a common musculoskeletal healthcare presentation with an expense of over $100 billion annually. The clinical effect of myofascial cupping on pain and function is not clear, especially when different cupping techniques are combined. The purpose of this case series was to explore changes in pain and function following local static and distal dynamic myofascial dry cupping treatments in patients with chronic low back pain.

Case Descriptions

Three adults from the general population received three ten-minute treatment sessions, 48 hours between each session, of static dry cupping to the low back followed by dynamic myofascial …

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

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

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 …

A Portable And Reliable Tool For On-Site Physical Reaction Time (Rt) Measurement, Brent Harper, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

The drop-stick test system (DTS) invention has the capability to measure reaction accurately for sideline mild traumatic brain injury (mTBI) assessment. The reaction time (RT) measurements showed moderate to good inter-instrument reliability with an overall ICC of 0.82 (95 % CI 0.78–0.85). RT is a useful biomarker of mTBI or concussion, but existing technologies in controlled laboratory environments are not feasible for assessments in the field. With wearable technologies and wireless connection with smartphones, it is now easier to conduct RT assessments on the field. The purpose was to develop a portable DTS involving wearable inertial sensors translatable from the …

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 …

Implementation Of Post-Covid Conditions Management Utilizing Interprofessional Collaboration In A Multi-Facility Healthcare Organization, Jocelin Friedman, Christina Dhesi-Bawa, Kathleen Kennedy, Stephen Lee, Leona Hidalgo

Physical Therapy Faculty Articles and Research

Background: The prevalence of Post-Covid Conditions (PCC) is estimated to affect 10-35% of infected individuals, with upwards of 85% of previously hospitalized individuals reporting prolonged effects. Literature indicates deficiencies in communication between healthcare providers which can negatively affect patients. Due to limited interprofessional communication, there was a scarcity of individuals with PCC receiving comprehensive therapy treatment on an outpatient basis. The multi-system nature of PCC was an indication for interprofessional collaboration and the development of workflows facilitating access to care.

Purpose: This qualitative study investigates the Post-COVID-19 Rehabilitation Program (PCRP) at a California, USA multi-facility healthcare system. The …

The Efficacy Of Manual Therapy On Hrv In Those With Long-Standing Neck Pain: A Systematic Review, Brent Harper, Parker Price, Megan Steele

Physical Therapy Faculty Articles and Research

Objectives

Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain.

Methods

Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane …

Soccer Heading Drills And Concussion-Related Deficits In High School Female Athletes, Brent Harper, Adrian Aron, Rahul Soangra

Physical Therapy Faculty Articles and Research

Repetitive head impacts from soccer heading may result in concussions in female athletes. Problem Statement: Concussion assessments exist with efforts to limit headers. Heading drills performed in different environments have conflicting results regarding influences on assessments. Approach: To evaluate, within an ecological realsetting environment with unpredictable conditions reflective of game situations, a heading drill’s effect on the King-Devick (K-D) and Biodex Biosway Balance Assessment (CTSIB-M). Preseason and post-heading metrics were taken for eleven female high school varsity soccer players (16 ± 1.4 years old) using K-D and CTSIB-M. K-D and CTSIB-M tests were repeated following a heading drill …

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 …

The Effect Of Spinal Muscle Fatigue And Psychosocial Factors On Pressure-Pain Threshold In Healthy Adults, Susan Mais, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Objective. Pain sensitivity decreases following isometric exercise. It is not clear whether this exercise-induced hypoalgesia (EIH) occurs to the same extent in men and women. It is also unclear if the effect is systemic or local to the exercised musculature. The aim of our study was to investigate whether fatiguing isometric exercise of the spinal and hip extensors would result in increased pressure pain threshold (PPT) at sites local to and remote from the exercised muscles in healthy men and women and whether there is a relationship between central sensitization, psychosocial factors, and PPT. Subjects. 35 healthy adults …

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 …

An Exploratory Analysis Of Gait Biomechanics And Muscle Activation In Pregnant Females With High And Low Scores For Low Back Or Pelvic Girdle Pain During And After Pregnancy, Jennifer J. Bagwell, Nicholas Reynolds, Jo Armour Smith, Michelle Walaszek, Hannah Runez, Kristina Lam, Julie Peterson, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy.

Methods

Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS

Findings

Nine participants met the high pain group criteria and 11 were low pain. During …

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 …