Medicine and Health Sciences Commons^™

Cost-Effectiveness Of High-Intensity Training Vs Conventional Therapy For Individuals With Subacute Stroke, T. George Hornby, Miriam Rafferty, Daniel Pinto, Dustin D. French, Neil Jordan

Physical Therapy Faculty Research and Publications

Objective

This investigation estimated the incremental cost-effectiveness of high-intensity training (HIT) compared with conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy.

Design

Secondary analysis from a pilot study and subsequent randomized controlled trial.

Setting

Outpatient laboratory setting.

Participants

Data were collected from individuals with locomotor impairments 1-6 months poststroke (N=44) who participated in HIT (n=27) or conventional physical therapy (n=17).

Interventions

Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional …

Using Asymmetry To Your Advantage: Learning To Acquire And Accept External Assistance During Prolonged Split-Belt Walking, Natalia Sánchez, Surabhi N. Simha, J. Maxwell Donelan, James M. Finley

Physical Therapy Faculty Articles and Research

People can learn to exploit external assistance during walking to reduce energetic cost. For example, walking on a split-belt treadmill affords the opportunity for people to redistribute the mechanical work performed by the legs to gain assistance from the difference in belts’ speed and reduce energetic cost. Though we know what people should do to acquire this assistance, this strategy is not observed during typical adaptation studies. We hypothesized that extending the time allotted for adaptation would result in participants adopting asymmetric step lengths to increase the assistance they can acquire from the treadmill. Here, participants walked on a split-belt …

Dynamic Body-Weight Support To Boost Rehabilitation Outcomes In Patients With Non-Traumatic Spinal Cord Injury: An Observational Study, Justin P. Huber, Lumy Sawaki

Neurology Faculty Publications

BACKGROUND: Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).

METHODS: This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). …

Automatic Detection Of Dynamic And Static Activities Of The Older Adults Using A Wearable Sensor And Support Vector Machines, Jian Zhang, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Although Support Vector Machines (SVM) are widely used for classifying human motion patterns, their application in the automatic recognition of dynamic and static activities of daily life in the healthy older adults is limited. Using a body mounted wireless inertial measurement unit (IMU), this paper explores the use of an SVM approach for classifying dynamic (walking) and static (sitting, standing and lying) activities of the older adults. Specifically, data formatting and feature extraction methods associated with IMU signals are discussed. To evaluate the performance of the SVM algorithm, the effects of two parameters involved in SVM algorithm—the soft margin constant …

Motor Compensation During Lower Limb Pedaling After Stroke, Brice Thomas Cleland

Dissertations (1934 -)

Long-term motor dysfunction in the lower limb is common after stroke. One potential contributor is motor compensation, a behavior in which functions originally performed by the paretic limb are performed by the non-paretic limb. Compensation in chronic stroke may contribute to long-term motor dysfunction by limiting functional ability, impairing future recovery, and eliciting maladaptive neuroplasticity. The purpose of this dissertation was to describe the impact of compensation on motor function and brain activation during lower limb pedaling and identify elements that produce this behavior. To achieve this purpose, we evaluated muscle activation and motor performance when compensation was prevented. During …

Analytical Cpg Model Driven By Limb Velocity Input Generates Accurate Temporal Locomotor Dynamics, Sergiy Yakovenko, Anton Sobinov, Valeriya Gritsenko

Faculty & Staff Scholarship

The ability of vertebrates to generate rhythm within their spinal neural networks is essential for walking, running, and other rhythmic behaviors. The central pattern generator (CPG) network responsible for these behaviors is well-characterized with experimental and theoretical studies, and it can be formulated as a nonlinear dynam- ical system. The underlying mechanism responsible for locomotor behavior can be expressed as the process of leaky integration with resetting states generating appropriate phases for changing body velocity. The low-dimensional input to the CPG model generates the bilateral pattern of swing and stance modulation for each limb and is consistent with the desired …

Altered Multifidus Recruitment During Walking In Young Asymptomatic Individuals With A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross sectional, laboratory study.

Background

Individuals with low back pain have impaired activation of multifidus during postural adjustments and increased activity of the erector spinae musculature during walking. However, it is unclear if these alterations in muscle activity are evident during locomotion in individuals with a history of low back pain when they are between symptomatic episodes.

Objectives

To compare paraspinal muscle activity in young healthy individuals and young individuals with a history of low back pain during walking turns.

Methods

14 asymptomatic individuals with a history of low back pain and 14 controls performed 90° walking turns …

Does Insertion Of Intramuscular Electromyographic Electrodes Alter Motor Behavior During Locomotion?, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low …

A Novel Fmri Paradigm Suggests That Pedaling-Related Brain Activation Is Altered After Stroke, Nutta-On Promjunyakul, Brian D. Schmit, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

The purpose of this study was to examine the feasibility of using functional magnetic resonance imaging (fMRI) to measure pedaling-related brain activation in individuals with stroke and age-matched controls. We also sought to identify stroke-related changes in brain activation associated with pedaling. Fourteen stroke and 12 control subjects were asked to pedal a custom, MRI-compatible device during fMRI. Subjects also performed lower limb tapping to localize brain regions involved in lower limb movement. All stroke and control subjects were able to pedal while positioned for fMRI. Two control subjects were withdrawn due to claustrophobia, and one control data set was …

Motor Cortex Electrical Stimulation Augments Sprouting Of The Corticospinal Tract And Promotes Recovery Of Motor Function, Jason B. Carmel, John H. Martin

Publications and Research

The corticospinal system—with its direct spinal pathway, the corticospinal tract (CST) – is the primary system for controlling voluntary movement. Our approach to CST repair after injury in mature animals was informed by our finding that activity drives establishment of connections with spinal cord circuits during postnatal development. After incomplete injury in maturity, spared CST circuits sprout, and partially restore lost function. Our approach harnesses activity to augment this injury-dependent CST sprouting and to promote function. Lesion of the medullary pyramid unilaterally eliminates all CST axons from one hemisphere and allows examination of CST sprouting from the unaffected hemisphere. We …

Changes In Hemodynamic Responses In Chronic Stroke Survivors Do Not Affect Fmri Signal Detection In A Block Experimental Design, Nutta-On Promjunyakul, Brian D. Schmit, Sheila Schindler-Ivens

Physical Therapy Faculty Research and Publications

The use of canonical functions to model BOLD-fMRI data in people post-stroke may lead to inaccurate descriptions of task-related brain activity. The purpose of this study was to determine whether the spatiotemporal profile of hemodynamic responses (HDRs) obtained from stroke survivors during an event-related experiment could be used to develop individualized HDR functions that would enhance BOLD-fMRI signal detection in block experiments. Our long term goal was to use this information to develop individualized HDR functions for stroke survivors that could be used to analyze brain activity associated with locomotor-like movements. We also aimed to examine the reproducibility of HDRs …

Effects Of Hemodialysis Therapy On Sit-To-Walk Characteristics In End Stage Renal Disease Patients, Rahul Soangra, Thurmon Lockhart, John Lach, Emaad M. Abdel-Rahman

Physical Therapy Faculty Articles and Research

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of …

Wavelet Based Automated Postural Event Detection And Activity Classification With Single Imu (Tempo), Thurmon E. Lockhart, Rahul Soangra, Jian Zhang, Xuefang Wu

Physical Therapy Faculty Articles and Research

Mobility characteristics associated with activity of daily living such as sitting down, lying down, rising up, and walking are considered to be important in maintaining functional independence and healthy life style especially for the growing elderly population. Characteristics of postural transitions such as sit-to-stand are widely used by clinicians as a physical indicator of health, and walking is used as an important mobility assessment tool. Many tools have been developed to assist in the assessment of functional levels and to detect a person’s activities during daily life. These include questionnaires, observation, diaries, kinetic and kinematic systems, and validated functional tests. …

The Effect Of Movement Rate And Complexity On Functional Magnetic Resonance Signal Change During Pedaling, Jay P. Mehta, Matthew D. Verber, Jon A. Wieser, Brian D. Schmit, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

We used functional magnetic resonance imaging (fMRI) to record human brain activity during slow (30 RPM), fast (60 RPM), passive (30 RPM), and variable rate pedaling. Ten healthy adults participated. After identifying regions of interest, the intensity and volume of brain activation in each region was calculated and compared across conditions (p < .05). Results showed that the primary sensory and motor cortices (S1, M1), supplementary motor area (SMA), and cerebellum (Cb) were active during pedaling. The intensity of activity in these areas increased with increasing pedaling rate and complexity. The Cb was the only brain region that showed significantly lower activity during passive as compared with active pedaling. We conclude that M1, S1, SMA, and Cb have a role in modifying continuous, bilateral, multijoint lower extremity movements. Much of this brain activity may be driven by sensory signals from the moving limbs.

Pedaling Alters The Excitability And Modulation Of Vastus Medialis H-Reflexes After Stroke, Dana P. Fuchs, Namita Sanghvi, Jon A. Wieser, Sheila Schindler-Ivens

Physical Therapy Faculty Research and Publications

Objective

Individuals post-stroke display abnormal Group Ia reflex excitability. Pedaling has been shown to reduce Group Ia reflexes and to normalize the relationship between EMG and reflex amplitude in the paretic soleus (SO). The purpose of this study was to determine whether these changes extend to the paretic quadriceps.

Methods

H-reflexes were used to examine Group Ia reflex excitability of the vastus medialis (VM). H-reflexes were elicited in paretic (n = 13) and neurologically intact (n = 13) individuals at 11 positions in the pedaling cycle and during static knee extension at comparable limb positions and levels of …

The Effects Of Shoe Traction And Obstacle Height On Lower Extremity Coordination Dynamics During Walking., Leslie Decker, Jeremy J. Houser, John M. Noble, Gregory M. Karst, Nicholas Stergiou

Journal Articles: Physical Therapy

This study aims to investigate the effects of shoe traction and obstacle height on lower extremity relative phase dynamics (analysis of intralimb coordination) during walking to better understand the mechanisms employed to avoid slippage following obstacle clearance. Ten participants walked at a self-selected pace during eight conditions: four obstacle heights (0%, 10%, 20%, and 40% of limb length) while wearing two pairs of shoes (low and high traction). A coordination analysis was used and phasing relationships between lower extremity segments were examined. The results demonstrated that significant behavioral changes were elicited under varied obstacle heights and frictional conditions. Both decreasing …

Nonlinear Time Series Analysis Of Knee And Ankle Kinematics During Side By Side Treadmill Walking, Jeff A. Nessler, Charles J. De Leone, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Nonlinear time series analysis was used to estimate maximal Lyapunov exponents of select ankle and knee kinematics during three different conditions of treadmill walking: independent, side by side, and side by side with forced synchronization of stepping. Stride to stride variability was significantly increased for the condition in which individuals walked side by side and synchronized unintentionally when compared to the conditions of forced synchronization and independent walking. In addition, standard deviations of three kinematic variables of lower extremity movement were significantly increased during the condition in which unintentional synchronization occurred. No relationship was found between standard deviation and estimates …

An Electromyographic And Electrogoniometric Study Of Stair Climbing With And Without The Use Of The Ez-Stepª And The Quad-Stepª, Rebecca Behrens, Catherine Gregoire, Tara Mathern, Jennifer L. Pederson

Physical Therapy Scholarly Projects

Purpose: The purpose of this study is to compare lower extremity muscle activity along with hip and knee ROM in an elderly population on stair ascent and descent using the EZ-StepTM and Quad-StepTM in comparison to traditional stair climbing.

Subjects: Twenty nine male and female adults volunteered for this study. Inclusion criteria included those 65 years of age and older, ability to climb three flights of standard stairs, and upper extremity strength to be able to manipulate the Quad-Step TM.

Instrumentation: The EZ-StepTM and Quad-StepTM are devices that decrease stair step height by one-half. The EMG activity and ROM was …

An Electromyographic And Goniometric Analysis Of The Lower Extremity During Stair Climbing With And Without The Use Of Ez-Steps® In An Elderly Population, Staci L. Fethkenher

Physical Therapy Scholarly Projects

Purpose: EZ-StepsTM is a device that fits into an existing stairwell which decreases the height, or rise, of each step by half. The purpose of this study was to determine if there is a difference in lower extremity muscle activity and knee joint range of motion (ROM) during stair climbing with and without the use of EZ-StepsTM in an elderly population.

Methods: Eight healthy, elderly (aged 65-89 years) male and female subjects volunteered for the study. Surface electromyography (sEMG) was used to assess muscle activity in four lower extremity muscles during stair climbing standard steps and steps installed with EZ-StepsTM. …