Medicine and Health Sciences Commons^™

Six-Month Pain And Function Outcome Expectations Were Established For Total Knee Arthroplasty Using The Smallest Worthwhile Effect, Daniel L. Riddle, Nancy Henderson

Physical Therapy Publications

Introduction: Interpretations of patient-reported outcome measures following knee arthroplasty lack context and typically do not account for costs, risks and benefits compared to an alternative treatment. The primary purpose of our paper is to estimate expectations patients have for pain and function destination outcome, six-months following surgery relative to the outcome expected if knee arthroplasty was not done. Secondary purposes were to determine if statistically significant changes in the smallest worthwhile six-month outcome occurred following an interactive discussion and to assess the construct validity of the expected six-month outcome obtained at baseline.

Methods: This was a secondary analysis …

The Environment Of Interprofessional Education In Graduate Education: Exploring Professional Programs Of Occupational Therapy, Physician Assistant, And Physical Therapy, Allison R. Kaczmarek

Theses and Dissertations

Interprofessional education (IPE) is an educational approach of increasing popularity in professional schools for the preparation of a collaborative ready healthcare workforce. The accrediting bodies of professional education programs in occupational therapy (OT), physician assistant (PA), and physical therapy (PT) have incorporated standards for outcomes addressing IPE. Although they have endorsed the Health Professions Accreditors Collaborative (HPAC) consensus document on quality IPE, we do not have a contemporary snapshot of the IPE environments in the curriculum of their accredited programs. This dissertation, a collection of three distinct inquiries, has two aims: first, to provide a description of IPE as it …

The Impact Of Patient Characteristics On Dysphagia Therapy Utilization And Feeding Outcomes For Premature Infants In The Neonatal Intensive Care Unit, Tiana Nguyen

Theses and Dissertations

Medical advances have significantly increased the survival rates of preterm infants at lower gestational ages. However, infants born at lower gestational ages have an increased risk for developmental disabilities and oral feeding difficulties. A stay in the neonatal intensive care unit (NICU) is very costly and inadequate oral feeding is the most common barrier to discharge for premature infants. Infants can receive dysphagia therapy services during their NICU stay that focuses on the development of oral feeding and swallowing skills. However, literature to this date has mainly focused on the impact of therapy services for premature infants after NICU discharge. …

Exploring The Effect Of Early Motor Delay And Physical Therapy Interventions On The Parent-Child Relationship, Rebecca Molinini

Theses and Dissertations

Emotional availability (EA) or the ability of the parent-child dyad to engage emotionally and partake in congruent and mutually enjoyable interactions, is essential for familial health and well-being. EA is considered the “connective tissue” of healthy parent-child relationships and is associated with secure attachment, maternal mental health, and children’s adaptive development. Most evidence supporting the integral role of EA on healthy outcomes is supported by typically developing populations in which adults present with a social or biological risk factor such as experiencing past traumas of adversities with mental health. In line with the transactional model of development, children are equal …

Nonpharmacological Practices For Reducing Agitation In Persons With Dementia, Meghan L. Farkas

Commonwealth Scholars Program

1 in 11 people aged 45 years and older experience subjective cognitive decline, with nearly a third identifying a decline in the ability to participate in social activities, work, or volunteering. There are twelve modifiable risk factors that can either increase or decrease an individual's possibility of developing Dementia. This can include excessive alcohol consumption, head injury, air pollution, lower education level, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact. These modifiable risk factors may prevent or delay up to 40% of dementias. Furthermore, many risk factors cluster around inequalities, which occur particularly in Black, …

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Intentions To Use Telerehabilitation For Communication And Treatment For Vision Impairments, Eric E. Hicks

Theses and Dissertations

BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …

Ectopic Pregnancy In A Woman With T9 Ais A Paraplegia Secondary To High-Grade Spinal Cord Pilocytic Astrocytoma, Elisabeth K. Acker

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma

Background

In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.

Methods

This is a case report on a female Veteran who initially presented to the …

Determining The Impact Of Increased Physical Activity On Improving Sleep Quality In Young Adults, Ashley Darling, Alex Chiu, Eric Henderson, Aaron Autler, Jennifer Weggen, Kevin Decker, Ryan Garten

Graduate Research Posters

Determining the Impact of Increased Physical Activity on Improving Sleep Quality in Young Adults

Disturbed sleep, defined as any alteration to normal sleep patterns, has been linked to poor cardiovascular health and an increase in cardiovascular disease (CVD) risk. These negative sleep patterns are highly prevalent with 35% to 41% of individuals in the United States reported some form of disturbed sleep. Although high amounts of physical activity (PA) are often associated with high sleep quality, little is known about PA’s effectiveness to improve different aspects of sleep (e.g. duration vs quality) and the mechanisms to which it can improve …

The Effects Of A High Fat Meal On Blood Flow Regulation During Arm Exercise, Alexander Chiu, Lauren Pederson, Jeremy O. Via, Natalie J. Bohmke, Jacob Richardson, Aaron Autler, Hunter Reed, Eric Henderson, R. Lee Franco, Ryan S. Garten

Graduate Research Posters

A diet high in saturated fats results in endothelial dysfunction and can lead to atherosclerosis, a precursor to cardiovascular disease. Exercise training is a potent stimulus though to mitigate the negative effects of a high saturated fat diet; however, it is unclear how high-saturated fat meal (HSFM) consumption impacts blood flow regulation during a single exercise session.

PURPOSE: This study sought to examine the impact of a single HSFM on peripheral vascular function during an acute upper limb exercise bout.

METHODS: Ten young healthy individuals completed two sessions of progressive handgrip exercise. Subjects either consumed a HSFM (0.84 g of …

Effects Of Dietary Sodium Intake On Blood Flow Regulation During Exercise In Salt Resistant Individuals, Kevin P. Decker, Morgan T. Kimmel, Hunter L. Reed, Alex H. Chiu, Austin C. Hogwood, Jennifer B. Weggen, Ashley M. Darling, Ryan S. Garten

Graduate Research Posters

PURPOSE: Dietary sodium intake guidelines is ≤2,300 mg/day, yet is exceeded by 90% of Americans. This study examined the impact of a high sodium diet on blood flow regulation during exercise. METHODS: Six males (25 ± 2 years) consumed dietary sodium intake guidelines for two weeks, with one week salt-capsule supplemented (HS: 6,900 mg/day of sodium) and the other week placebo-capsule supplemented (LS: 2,300 mg/day of sodium). At the end of each week, peripheral hemodynamic measurements [blood flow (BF), shear rate (SR), and flow mediated dilation (FMD)/SR)] of the brachial and superficial femoral artery were taken during handgrip (HG) and …

Vascular Dysfunction And Posttraumatic Stress Disorder: Examining The Role Of Oxidative Stress And Sympathetic Activity, Jennifer Weggen, Aaron Autler, Gina Tuzzolo, Austin C. Hogwood, Ashley M. Darling, Kevin P. Decker, Ryan S. Garten

Graduate Research Posters

Purpose: The physiological manifestations of posttraumatic stress disorder (PTSD) have been associated with an increase in risk of cardiovascular disease (CVD) independent of negative lifestyle factors. The goal of the study was to better elucidate the mechanisms behind the increased CVD risk by examining peripheral vascular function, a precursor to CVD. Moreover, this study sought to determine the role of oxidative stress and sympathetic nervous system (SNS) activity in PTSD-induced vascular dysfunction.

Methods: Sixteen individuals with PTSD (10 women, 6 men; age 24 ± 4 years), and twenty-four healthy controls (CTRL; 15 women, 9 men, 24 ± 4 years), participated …

Six Weeks Of Resveratrol Improves Cardiovascular Health In Patients With Copd, Rebekah Lavender, Kolton Cobb, Kendall Goldman, Paula Rodriguez-Miguelez Phd

Graduate Research Posters

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. One-third of people diagnosed with COPD die of cardiovascular (CV) complications as opposed to pulmonary. Despite these odds, there are no therapies that mitigate this important health issue. Resveratrol, a naturally occurring antioxidant, improves CV health in other populations. However, there is currently no literature on resveratrol in patients with COPD. The purpose of this pilot study was to test if six weeks of resveratrol supplementation could improve CV health in patients with COPD. METHODS: A randomized, double-blind, pilot trial was completed in 8 patients with …

“It’S Supposed To Be Super Easy And It’S Not”: Black And Latinx Student Experiences In The Doctor Of Physical Therapy Admissions Process, Melissa Yeung

Theses and Dissertations

Data provided by the Physical Therapy Central Application System (PTCAS) suggests that despite the large numbers of applicants to Doctor of Physical Therapy (DPT) programs on an annual basis, a gap remains between the number of White and Black and Latinx applicants who are offered admission to DPT programs. Efforts made by DPT programs to increase the diversity of their incoming cohorts include the use of holistic review processes and enrichment programs to recruit more diverse classes. However, research suggests that the undergraduate experiences of students of color have an impact on their aspirations to graduate and professional schools, and …

The Impact Of Occupational Therapy Acute Care Services On Readmission Rates For Patients In Medicare’S Hospital Readmission Reduction Program, Jessica M. Edelstein

Theses and Dissertations

The United States (US) health care system is faced with the daunting challenge to make healthcare payments commensurate with quality of care provided. To assess quality, metrics for reimbursement have been established by Medicare. One such quality metric is hospital readmissions (readmissions). Readmissions are associated with poor patient outcomes and costly. Associated poor patient outcomes include higher risk for mortality, deconditioning, nutritional issues and cognitive impairments. As a result, readmissions cost Medicare $26 billion annually. Current strategies for reducing readmissions in the US are fragmented and hospital-specific. While specific strategies may vary, hospitals that have low readmissions rates tend to …

The Effect Of Intermittent Theta Burst Stimulation On Biceps Corticomotor Excitability In Non-Impaired Individuals And Individuals With Tetraplegia, Blaize Majdic

Theses and Dissertations

Neuromodulation of the primary motor cortex (M1) in pair with physical therapy may be a promising method for improving motor outcomes after spinal cord injury (SCI). Increased excitability of the corticospinal motor pathways (i.e. corticomotor excitability) has shown to be associated with improved motor learning and skill acquisition. Intermittent theta burst stimulation (iTBS) is a form of non-invasive brain stimulation which can increase corticomotor excitability, as measured by an increase in the amplitude of motor evoked potentials (MEPs). However, the ability for iTBS to increase the corticomotor excitability of proximal muscles such as the biceps, and muscles affected by spinal …

Relationship Of Demographic Characteristics Of Occupational And Physical Therapists Towards Their Knowledge And Attitude On Person-Centered Care In Skilled Nursing Facilities, Sadashiv R. Aggarwal

Theses and Dissertations

The study aimed to assess the relationship of specific demographic characteristics of occupational (OTs) and physical therapists (PTs) with their knowledge and attitudes towards principles of Person-Centered Care (PCC) in skilled nursing facilities (SNFs). The study further examined if knowledge and/or attitudinal differences exist between OTs and PTs towards PCC. The proposed descriptive study used the Person-Centered Care theory, which is a holistic (bio-psychosocial-spiritual) health care delivery approach. PCC delivers services that are respectful and individualized, allowing negotiation of care, and offering choice through a therapeutic relationship where persons receiving care are empowered to be involved in health decisions at …

A Review Of Factors, Seating Design, And Shape Capture Methods For Reducing Pressure Injury Risk, John A. Damiao

Theses and Dissertations

This dissertation in the form of three papers ready for submission to peer-reviewed journals is submitted toward the requirements of the PhD in Health Related Sciences program at Virginia Commonwealth University. Chapter One provides an introductory overview of the project, including: (a) an overview of pressure injuries, (b) the impact of seating as an intervention, and (c) aims of the three-paper dissertation in addressing various aspects of pressure injury prevention. Each paper is unique and singular in its focus, yet all share the overlying aim of addressing pressure injury risk associated with wheelchair seating. Paper One describes the unique facilitators …

Supporting Play Exploration And Early Developmental Intervention Versus Usual Care To Enhance Development Outcomes During The Transition From The Neonatal Intensive Care Unit To Home: A Pilot Randomized Controlled Trial, Stacey C. Dusing, Tanya Tripathi, Emily C. Marcinowski, Leroy R. Thacke, Lisa F. Brown, Karen D. Hendricks-Muñoz

Physical Therapy Publications

Background

While therapy services may start in the Neonatal Intensive Care Unit (NICU) there is often a gap in therapy after discharge. Supporting Play Exploration and Early Development Intervention (SPEEDI) supports parents, helping them build capacity to provide developmentally supportive opportunities starting in the NICU and continuing at home. The purpose of this single blinded randomized pilot clinical trial was to evaluate the initial efficacy of SPEEDI to improve early reaching and exploratory problem solving behaviors.

Methods

Fourteen infants born very preterm or with neonatal brain injury were randomly assigned to SPEEDI or Usual Care. The SPEEDI group participated in …

An Innovative Use Of Technology And Associative Learning To Assess Prone Motor Learning And Design Interventions To Enhance Motor Development In Infants, Tanya Tripathi

Theses and Dissertations

Since the introduction of the American Academy of Pediatrics Back to Sleep Campaign infants have not met the recommendation to “incorporate supervised, awake “prone play” in their infant’s daily routine to support motor development and minimize the risk of plagiocephaly”. Interventions are needed to increase infants’ tolerance for prone position and prone playtime to reduce the risk of plagiocephaly and motor delays. Associative learning is the ability to understand causal relationship between events. Operant conditioning is a form of associative learning that occurs by associating a behavior with positive or negative consequences. Operant conditions has been utilized to encourage behaviors …

Influence Of Muscle Strength On Mobility In Critically Ill Adult Patients On Mechanical Ventilation, Audrey R. Roberson

Theses and Dissertations

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence …

The Cognitive And Functional Impact Of Open Heart Surgery: A Pilot Study Including Three Common Procedures (Coronary Artery Bypass Graft, Heart Valve Replacement, And Left Ventricular Assist Device), Robert Fix

Theses and Dissertations

This study investigated the impact of open heart surgery (Coronary Artery Bypass Graft, Heart Valve Replacement, or Left Ventricular Assist Device placement) on cognition, functional performance, and mood in the three months following surgery. The Montreal Cognitive Assessment (MoCA), Kettle Test (KT), Physical Self Maintenance Scale (PSMS), and Hospital Anxiety and Depression Scale (HD) measured global cognition, functional cognition, functional performance, and mood states, respectively.

Thirteen male participants (ages 38 – 75) completed assessments at four time points -- when they were scheduled for surgery, within one week prior to surgery, before hospital discharge after surgery, and three months after …

Can Real-Time Visual Feedback During Gait Retraining Reduce Metabolic Demand For Individuals With Transtibial Amputation?, Elizabeth R. Esposito, Harmony S. Choi, Benjamin J. Darter, Jason M. Wilken

Physical Therapy Publications

The metabolic demand of walking generally increases following lower extremity amputation. This study used real-time visual feedback to modify biomechanical factors linked to an elevated metabolic demand of walking in individuals with transtibial amputation. Eight persons with unilateral, traumatic transtibial amputation and 8 uninjured controls participated. Two separate bouts of real-time visual feedback were provided during a single session of gait retraining to reduce 1) center of mass sway and 2) thigh muscle activation magnitudes and duration. Baseline and post-intervention data were collected. Metabolic rate, heart rate, frontal plane center of mass sway, quadriceps and hamstrings muscle activity, and co-contraction …

Recovery From Design, Cassandra J. Ellison

Theses and Dissertations

Through research, inquiry, and an evaluation of Recovery By Design, a ‘design therapy’ program that serves people with mental illness, substance use disorders, and developmental disabilities, it is my assertion that the practice of design has therapeutic potential and can aid in the process of recovery. To the novice, the practices of conception, shaping form, and praxis have empowering benefit especially when guided by Conditional and Transformation Design methods together with an emphasis on materiality and vernacular form.

Altering A Runner’S Foot Strike Using A Modified Elliptical Trainer, Daniel Shull

Theses and Dissertations

One possible solution to common running related injuries is to transition runners from a rearfoot strike during initial contact to a midfoot strike. Natural rearfoot strike runners were studied to see if a modified elliptical trainer could be used to alter their running pattern to that of a midfoot strike runner. Their results were compared to subjects who ran on a non-modified elliptical trainer. After training on the modified elliptical trainer, subjects demonstrated a decrease in foot angle at initial contact when attempting to run with a midfoot strike. Training did not affect all kinetic metrics or stride frequency. However, …

The Impact Of Chemotherapy And Radiotherapy For Breast Cancer On Cognition And Functional Performance: A Comparative Analysis Of Survey Data Taken At Three Time Points Post-Treatment, Ann Marie Potter

Theses and Dissertations

Cognitive impairment related to treatment for breast cancer, affects as many as 75% of patients in study samples (Jansen, Cooper, Dodd & Miaskowski, 2011). Deficits in the cognitive domains of short-term memory, attention, speed of information processing, judgment, reasoning, spatial attention, and verbal memory have been documented. The extent to which these deficits impact functional performance within this population has not yet been quantified. The purpose of this study was to investigate the impact of breast cancer on self-reported cognition and functional performance in the six months post-completion in two groups of breast cancer survivors, a chemotherapy group and chemotherapy …

Infant Hand Preference And The Development Of Cognitive Abilities, George F. Michel, Julie M. Campbell, Emily C. Marcinowski, Eliza L. Nelson, Iryna Babik

Physical Therapy Publications

Hand preference develops in the first two postnatal years with nearly half of infants exhibiting a consistent early preference for acquiring objects. Others exhibit a more variable developmental trajectory but by the end of their second postnatal year, most exhibit a consistent hand preference for role-differentiated bimanual manipulation. According to some forms of embodiment theory, these differences in hand use patterns should influence the way children interact with their environments, which, in turn, should affect the structure and function of brain development. Such early differences in brain development should result in different trajectories of psychological development. We present evidence that …

In-Shoe Plantar Pressure System To Investigate Ground Reaction Force Using Android Platform, Ahmed A. Mostfa

Theses and Dissertations

Human footwear is not yet designed to optimally relieve pressure on the heel of the foot. Proper foot pressure assessment requires personal training and measurements by specialized machinery. This research aims to investigate and hypothesize about Preferred Transition Speed (PTS) and to classify the gait phase of explicit variances in walking patterns between different subjects. An in-shoe wearable pressure system using Android application was developed to investigate walking patterns and collect data on Activities of Daily Living (ADL). In-shoe circuitry used Flexi-Force A201 sensors placed at three major areas: heel contact, 1st metatarsal, and 5th metatarsal with a PIC16F688 microcontroller …

Male And Female Runners Demonstrate Different Sagittal Plane Mechanics As A Function Of Static Hamstring Flexibility, D. S. Blaise Williams Iii, Lee M. Welch

Physical Therapy Publications

Background:

Injuries to runners are common. However, there are many potential contributing factors to injury. While lack of flexibility alone is commonly related to injury, there are clear differences in hamstring flexibility between males and females.

Objective:

To compare the effect of static hamstring length on sagittal plane mechanics between male and female runners.

Method:

Forty subjects (30.0±6.4 years) participated and were placed in one of 4 groups: flexible males (n=10), inflexible males (n=10), flexible females (n=10), and inflexible females (n=10). All subjects were free of injury at the time of data collection. Three-dimensional kinematics and kinetics were collected while …