Medicine and Health Sciences Commons^™

Assessment Of Gait, Balance, And Falls In Individuals With Neurodegenerative Diseases, Lauren Tueth

WUSM Theses and Dissertations – All Programs

Neurodegenerative diseases are a group of disorders that impact the brain and lead to neuronal degeneration. This degeneration causes many different symptoms, which are often grouped into motor, cognitive, and psychiatric domains. Individuals with these disorders can experience symptoms from multiple domains at the same time, but little is known about how these distinct symptoms may impact each other.

In Chapter 2, we explored the intersection of balance and cognitive impairment in individuals with Alzheimer disease (AD). AD is traditionally discussed in the context of the dementia symptoms, but people with AD also experience motor deficits. Falls are a huge …

Limb Speed Perception Accuracy In Neurodegenerative Disease, Brandmeir Lynn Cheryl

Graduate Theses, Dissertations, and Problem Reports

Movement is a fundamental human activity, enabling us to engage with our surroundings. Consequently, a well-operating neuromuscular system is essential for maintaining quality of life. Motion is not only integral for the basic function of daily living, but also plays a significant role in enhancing our physical, mental, and emotional health. The importance of this system becomes abundantly clear when it is compromised, such as with neurodegenerative disease.

Alzheimer’s disease (AD), followed by Parkinson’s disease (PD) are the two most common neurodegenerative diseases that profoundly affect millions of individuals worldwide (Lamptey et al., 2022). Characterized by distinct but sometimes overlapping …

The Effects Of Exercise Training On Gait In Adults With Down Syndrome, Anna Lois Aquino, Sandra Daugherty, Alex Palko

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Down syndrome (Ds) is a genetic disorder in which the individual carries an extra copy of chromosome 21 resulting in mental and physical disabilities and risk of major health conditions. A high prevalence of gait pattern dysfunction occurs in adults with Ds due to muscle hypotonia, ligamentous laxity, joint hypermobility, and altered development of musculoskeletal structure, which often lead to increased falls and fear of falling. The purpose of this study is to investigate the differences in kinematic and spatiotemporal gait parameters between adults with Ds and age-matched controls, as well as studying the effects of a 12-week Ds-specific …

The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/purpose: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ), developed in 2011 to measure fear of falling avoidance behavior, has good evidence for reliability and validity. However, a recently modified version (mFFABQ) is theorized to be easier to understand for those completing the questionnaire because the Likert responses are more logical in completing the item stem. The purpose of this study was to examine the test-retest reliability and construct validity of the mFFABQ in adults with Parkinson’s Disease (PD) and older adults aged 60-90 years. Methods: Thirty-nine participants (age 72.21 ± 9.5; 29 men, 10 women) diagnosed with PD (diagnosis …

Contributions Of Asymmetry And Instability To Transfer And Retention Following Locomotor Adaptation, Daniel L. Gregory

Doctoral Dissertations

Gait asymmetry resulting from neurological injury is more costly and less stable than healthy gait. Split-belt treadmills, which drive limbs at different speeds, lead to spatial and temporal gait asymmetries, and perturb walking balance, have been used to study locomotor adaptability and learning related to asymmetry and stability. This knowledge may be leveraged to design more effective rehabilitation protocols. In experiment 1, we asked how constraining stride-rates away from preferred during split-belt walking influences learning revealed in a retention test. We found that constraints to stride rate during asymmetric walking uncovered the capacity to leverage redundant degrees-of-freedom for walking control, …

Exploring The Inter-Relationship Between Cognitive And Motor Function In People With Lower Limb Amputations, Humberto Adolfo Omaña Moreno

Electronic Thesis and Dissertation Repository

The main objective of the present dissertation was to expand our understanding of the inter-relationship between cognition and mobility in people with lower limb amputations (PLLA). Study 1 systematically reviewed the literature to assess the effects of dual-task testing on the balance and gait of PLLA. A total of twenty-two studies were included. Overall, PLLA demonstrated a disproportionately greater dual-task effect than controls, characterized by increased sway velocity and reduced pace and rhythm, and increased asymmetry when balance or walking was paired with a secondary task. Additionally, the dual-task effect was not influenced by differences in etiology, level of amputation, …

Development And Application Of 3d Kinematic Methodologies For Biomechanical Modelling In Adaptive Sports And Rehabilitation, Anne Marie Severyn

All Dissertations

Biomechanical analysis is widely used to assess human movement sciences, specifically using three-dimensional motion capture modelling. There are unprecedented opportunities to increase quantitative knowledge of rehabilitation and recreation for disadvantaged population groups. Specifically, 3D models and movement profiles for human gait analysis were generated with emphasis on post-stroke patients, with direct model translation to analyze equivalent measurements while horseback riding in use of the alternative form of rehabilitation, equine assisted activities and therapies (EAAT) or hippotherapy (HPOT). Significant improvements in gait symmetry and velocity were found within an inpatient rehabilitation setting for patients following a stroke, and the developed movement …

Comparative Kinematic Gait Analysis In Adults With Multiple Disabilities, Lauren Rumbalski

Undergraduate Honors Thesis Projects

The purpose of this research is to identify abnormal gait parameters or patterns amongst young adults with multiple disabilities enrolled in a work transition program sponsored by a public-school system. Gait disorders are commonly seen in individuals with neurologic disorders, with significant research in children with autism. Gait disorders have been linked with fall and injury risk, with significant research in elderly populations. Gait analysis technology can be used to identify gait characteristics in populations that are abnormal or contribute to gait disorders. In an observational design, students from the transitional program promoted by Westerville City Schools, housed on Otterbein …

Does Biofeedback Increase Gait Velocity In Children With Cerebral Palsy?, Kara L. Steck

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Does biofeedback increase gait velocity in children with cerebral palsy (CP)?”.

Study Design: A systematic review of three randomized control trials (RCTs) published between 2014 and 2019.

Data Sources: All three RCTs were found using PubMed. Each article was published in English in peer reviewed journals and selected based on their applicability to the clinical question, provide a new technique in CP rehabilitation, and include patient-oriented outcomes (POEMS).

Outcome Measured: The outcome measured was gait velocity before and after treatment using Tekscan software, 3D motion analysis …

A Vicious Cycle Of Fear Of Falling Avoidance Behavior In Parkinson’S Disease: A Path Analysis, Kameron Jacobson, Nicole Matsunami, Hannah Mccarl, Michelle Regis

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Postural instability (PI) in Parkinson’s disease (PD) is associated with several negative down- stream consequences. Objective: The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance con!dence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. Methods: A path analysis of cross!sectional data from 55 participants with PD was conducted. The four con- structs in the model connected in succession were: 1. PI (principal …

The Effect Of Obstacle Intervals On Foot Integrated Pressure And Obstacle Negotiation Strategy, Zhuo Wang

Theses & Dissertations

When stepping over a single obstacle, despite of some spatiotemporal parameter changes, the impulse of the leading and trailing leg stays the same. This is considered an efficient obstacle avoidance strategy. However, research has shown that the strategy of multiple obstacles negotiation is different from a single obstacle crossing. Would this efficient strategy still exist during multiple obstacles negotiation? This study attempted to answer this question. Nineteen healthy young adults were recruited in this study. Each participant was required to complete 15 trials under 3 conditions: one-step, two-step, and three-step intervals. Data were collected for foot integrated pressure (FIP), walking …

Ankle Muscle Activation And Mechanics During The Ebbet's Foot Drills, Quentin Adam Archuleta

Theses, Dissertations and Capstones

Introduction: The ankle is a complex structure of three joints that allow multiplanar motion (Brockett & Chapman, 2016). Lateral ankle sprains (LAS) are the most common injury seen today in both the general and athletic populations and have a high recurrence rate. When left untreated or mistreated, it often leads to developing chronic ankle instability or osteoarthritis, which a lower quality of life. Dr. Russ Ebbets created a set of foot drills with the claim that they can strengthen the muscles of the lower leg, lessen lower leg aliments, and the chances of a severe ankle sprain (Ebbets, 2011a). …

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 …

Joint Loading Factors Of Articular Cartilage Structure In Healthy And Acl-Injured Knees, Elizabeth Wellsandt

Theses & Dissertations

Articular cartilage structure and chondrocyte health are sensitive and reliant on dynamic joint loading during activities. The risk of osteoarthritis (OA) is high after anterior cruciate ligament (ACL) injury, but mechanisms underlying its development are poorly understood. The overall goals of this work were 1) to determine the association between measures of individual and cumulative knee joint loading with T2 relaxation times in the knee cartilage of young individuals without injury and 2) to determine if these same knee joint loading factors are associated with cartilage T2 relaxation time one month after ACL injury. The central hypotheses was that lower …

Validation Of An Inertial-Measurement-Unit System For Calculating Hip And Knee Flexion Angles During Gait, Joonsun Park

Master's Theses

Technological advances regarding Inertial Measurements Units (IMUs) have positioned this type of sensor as an alternative for camera-based motion capture. This study introduces a new IMU based system (IMU_sys) to measure hip and knee flexion angles. PURPOSE: To validate the use of a five-sensor IMU_sys for the measurement of knee and hip flexion angles during gait in adults and pediatrics at two different time points. METHODS: Bilateral hip and knee flexion patterns (LH, RH, LK, and RK) of twenty-two healthy participants (12 adults and 10 pediatric) between the ages of 8 – 35 years were investigated. Participants …

Rhythmic Auditory Cueing Of Gait In Parkinson Disease, Adam Patrick Horin

Arts & Sciences Electronic Theses and Dissertations

Parkinson disease (PD) is a neurodegenerative movement disorder characterized by motor complications such as gait deficits and is caused by the depletion of dopamine producing neurons in the basal ganglia (BG). Gait deficits, including decreased velocity and increased variability, are among the most debilitating symptoms of PD and lead to an increased risk of falls. Common pharmacological treatments do not target many gait symptoms. Therefore, gait rehabilitation methods that can improve these deficits in gait are highly important. A common form of gait rehabilitation is known as rhythmic auditory cueing, in which an individual matches their footfalls to the beat …

The Effects Of Somatosensory Input On Gait In Individuals Post-Stroke, Victor Hung, Amanda Reilly, Rachel Wood, Nikita Yuskov

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is a leading cause of disability that results in various neurological deficits, one of which is hemiplegia. This deficit alters the gait cycle, resulting in decreased propulsion force by plantar flexor muscles, decreased activation of dorsiflexor (DF) muscles, and increased coactivation of antagonistic ankle muscles. Stroke also leads to altered somatosensory input which results in decreased balance and gait speed, ultimately increasing fall risk. Therapies targeting increased somatosensory input have been shown to be beneficial in stroke as well as other neurological populations. However, no known studies have investigated the acute effects of local vibration to …

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, …

Optimizing Gait Outcomes In Parkinson's Disease With Auditory Cues: The Effects Of Synchronization, Groove, And Beat Perception Ability, Emily A. Ready

Electronic Thesis and Dissertation Repository

This dissertation explores a common, rehabilitative strategy for mitigating gait impairments in Parkinson’s disease (PD) called Rhythmic Auditory Stimulation (RAS). The effects of this intervention on gait in PD are well documented but highly variable, which poses difficulty for appropriate therapeutic application. Part of this variability may be related to individual musical abilities, such as beat perception accuracy, as most RAS interventions involve synchronizing with a beat. However, music is complex and variable. Therefore, factors inherent in the music itself may play a role in these differences, such as how much the music makes you want to move (groove), or …

The Effect Of A Novel Rehabilitation Program On Walking Performance In Persons With Multiple Sclerosis, Alyssa J. Rebensburg

All NMU Master's Theses

The purpose of this study was to compare if the addition of the NewGait™ device to traditional therapy in comparison to traditional therapy alone would be more effective at improving walking technique and walking performance in persons with multiple sclerosis. Eighteen patients with multiple sclerosis participated in this study. Pre- and post-testing assessed kinematic gait variables (speed, step length, step width, double limb support time), toe clearance height, ankle range of motion, balance confidence, rating of perceived exertion, and hip-ankle coordination. Participants completed an 8-week physical therapy protocol aimed to improve gait and balance with the experimental group wearing the …

The Impact Of Anterior Cruciate Ligament Reconstructive Surgery On Neuromotor Function, Cortney Noel Armitano

Rehabilitation Sciences Theses & Dissertations

The purpose of this dissertation was to examine the systemic neuromechanical implications in individuals who have had an ACL reconstruction (ACLR) compared to healthy controls. The specific aims addressed were to: 1) examine differences in inter-limb coordination during walking at different speeds, 2) examine differences in trunk, neck and head acceleration during gait, and 3) investigate whether the reaction time responses assessed during stepping are negatively affected by ACLR.

The findings of study 1 revealed that maximal coordination stability was achieved when walking at the person’s preferred gait speed. However, individuals with a previous ACLR exhibited reduced coordination stability between …

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …

Immediate Effects Of Cervical Spine Thrust Joint Manipulation On Gait Parameters In Individuals With Neck Pain, Marc Anthony D. Albano, Emily Blok, Beau Gronert, Ryan Masuda

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypotheses: 1. To investigate for any change in gait parameters in individuals with neck pain while walking with different functional neck conditions immediately following cervical thrust joint manipulation (TJM) versus a sham intervention. 2. To investigate any association between Global Rating of Change (GROC) scores and gait parameters immediately following cervical thrust joint manipulation versus a sham intervention. The hypotheses were that, a) cervical TJM would have an immediate effect on gait parameters during walking with the neck in at least one of three conditions (neutral, flexion/extension and rotation) among individuals with neck pain; and b) higher scores on the …

Neuromuscular Adaptations Following Slope Walking In Individuals Post-Stroke, Eric Akoopie, Brooke Conway Kleven, Trisha Koch

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: The excitability of the H-reflex pathway in the non-impaired nervous system can be augmented by altering the different parameters of a walking task, specifically slope. We sought to examine the adaptations in soleus H-reflex excitability and foot force control following an acute bout of upslope or downslope treadmill walking in people post-stroke compared to those who are non- impaired. Methods: We recruited 12 individuals with chronic post-stroke hemiparesis and 9 age-similar non- neurologically impaired individuals. Each subject was tested over 2 sessions separated by at least 7 days. For each session, subjects walked at a self-selected walking speed on …

Efficacy Of Rhythmic Acquisition On Gait Performance Among Individuals With Parkinson’S Disease, Demian L. Kogutek

Electronic Thesis and Dissertation Repository

The purpose of this study was to identify the ability of individuals with Parkinson’s disease (PD) to acquire different rhythmic complexity levels through individual home-based Improvised Active Music Therapy (IAMT) sessions. The study aimed to identify whether higher acquisition of rhythmic complexity levels improved gait performance, as well as beat perception and production abilities. In this single subject multiple baseline design, the study measured the ability of four right-handed participants with PD to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. An accredited music therapist led …

Differences In Walking Mechanics Between A Traditional Walker And The Kb Balance Trainer, Silvia Zanini

Electronic Theses and Dissertations

INTRODUCTION: Millions of individuals with ambulatory difficulties rely on walking aids to maintain independence and mobility. However, users of traditional walkers typically exhibit increased forward lean of their trunk while using the assistive device. The KB Balance Trainer is a new posterior walker designed to facilitate a more erect position during gait. PURPOSE: To compare gait mechanics across three walking conditions: unassisted, using a traditional walker, and using the KB Balance Trainer. METHODS: Seven adults with experience using walkers due to ambulatory difficulties participated in the study. The study consisted of one training session and one gait analysis session. The …

Effects Of Functional Electrical Stimulation Cycling Versus Cycling Only On Walking Performance And Quality Of Life In Individuals With Multiple Sclerosis: A Randomized, Clinical Pilot Study, Lori Hochman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Functional Electrical Stimulation (FES) stimulates peripheral nerves via electrical current to evoke muscle contractions and when combined with lower extremity cycling (LE), creates patterned leg movements. Previous studies demonstrated FES cycling is safe and effective in the spinal cord injury and stroke populations with improvements seen in walking speed, muscle mass, and bone density. Few studies have applied FES cycling to a neurodegenerative disorder, such as multiple sclerosis (MS). The aim of this study is to assess the effect of an 8-week training program using FES cycling, compared to Cycling Only, in people with MS (PWMS). Methods: Using a …

Dual-Task Gait Assessment In Lower Extremity Amputees, Courtney A. Frengopoulos

Electronic Thesis and Dissertation Repository

The purpose of these studies was to develop a reliable dual-task functional mobility protocol and investigate changes in dual-task performance over time in lower extremity amputees. Relative and absolute test-retest reliability of the protocol were evaluated across the population in a study consisting of three groups, with 20 participants per group. A pilot study of 16 participants investigated change in dual-task performance between discharge from rehabilitation and follow-up for both cognitively normal and cognitively impaired individuals. Gait was assessed by the developed protocol as well as an electronic walkway (GaitRITE®). All three groups in Study 1 had excellent relative test-retest …

The Effects Of Fatigue On Balance In Individuals With Parkinson's Disease: Influence Of Medication And Brain-Derived Neurotrophic Factor Genotype, Michael Baer, Bradley Klemetson, Diana Scott

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The purpose was to investigate the effects of fatigue on balance in individuals with Parkinson’s disease (PD). Because falls in this population can have deleterious consequences, it is important to understand the influence of fatigue and PD medications on balance. Additionally, since brain-derived neurotrophic factor (BDNF) has been shown to be related to motor performance, we explored its role in balance fatigue. Participants: 27 individuals (age= 65.4±8.1; males= 14, females= 13) with neurologist-diagnosed PD. Of the 27, 13 were genotyped for BDNF as Val/Val, 11 as Val/Met, 2 as Met/Met, and one refused genotyping. Methods: Participants were …

Chronic Ankle Instability And Aging, Kyle B. Kosik

Theses and Dissertations--Rehabilitation Sciences

Lateral ankle sprains are the most common musculoskeletal injury among the general population and U.S. military personnel. Despite the common perception of being a minor injury, at least 1 out of 3 individuals with a previous ankle sprain will develop chronic ankle instability (CAI). This clinical phenomenon creates a significant barrier for patients to return to their prior level of physical function. Specifically, CAI is associated with reductions in physical activity level, leading to decreases in lower health-related quality of life and increase risk of developing of post-traumatic ankle osteoarthritis. Current evidence has largely focused on characterizing the mechanical and …