Medicine and Health Sciences Commons^™

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 …

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 …

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 …

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

High Definition Tdcs Effect On Postural Control In Healthy Individuals: Entropy Analysis Of A Crossover Clinical Trial, Diandra B. Favoretto, Eduardo Bergonzoni, Diego Carvalho Nascimento, Francisco Louzada, Tenysson W. Lemos, Rosangela A. Batistela, Renato Moraes, João P. Leite, Brunna P. Rimoli, Dylan J. Edwards, Taiza G.S. Edwards

Research outputs 2022 to 2026

Objective: Converging evidence supporting an effect of transcranial direct current stimulation (tDCS) on postural control and human verticality perception highlights this strategy as promising for post-stroke rehabilitation. We have previously demonstrated polarity-dependent effects of high-definition tDCS (HD-tDCS) on weight-bearing asymmetry. However, there is no investigation regarding the time-course of effects on postural control induced by HD-tDCS protocols. Thus, we performed a nonlinear time series analysis focusing on the entropy of the ground reaction force as a secondary investigation of our randomized, double-blind, placebo-controlled, crossover clinical trial. Materials and Methods: Twenty healthy right-handed young adults received the following conditions (random order, …

Corticospinal Activity During A Single-Leg Stance In People With Chronic Ankle Instability, Masafumi Terada, Kyle B. Kosik, Ryan S. Mccann, Colin Drinkard, Phillip A. Gribble

Rehabilitation Sciences Faculty Publications

Purpose: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls.

Methods: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.

Results: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to …

Cross-Education Balance Effects After Unilateral Rehabilitation In Individuals With Chronic Ankle Instability: A Systematic Review, Briana Lawry-Popelka, Sunghoon Chung, Ryan S. Mccann

Rehabilitation Sciences Faculty Publications

Objective: To conduct a systematic review of existing literature on cross-education balance effects after unilateral training in the population with chronic ankle instability (CAI).

Data Sources: PubMed, SPORTDiscus, CINAHL Plus.

Study Selection: To be included in the systematic review, studies were required to have been published in English, included participants with CAI, had participants undergo a unilateral therapeutic exercise for the lower extremity, and measured balance performance of the untrained lower extremity before and after the intervention.

Data Extraction: The certainty of evidence in each included study was assessed via the Downs and Black checklist. A score of 24 to …

The Effects Of Hippotherapy On Postural Control In Children With Cerebral Palsy: A Systematic Review, Anamarie Rogers, Paisha Glisson

Student Research Poster Presentations 2021

The Effects of Hippotherapy on Postural Control in Children with Cerebral Palsy

Study Design: Systematic Review

Purpose: The purpose of this systematic review is to summarize and evaluate the most recently published research focusing on the effects of hippotherapy on postural control in children with cerebral palsy.

Methods and Measures: Two searches of literature were performed, the first in August 2020 and January 2021, using PubMed, Academic Search Ultimate and ScienceDirect databases. Peer reviewed hippotherapy and hippotherapy simulator studies for children aged 2-25 with cerebral palsy that examined postural control were included. Articles published prior to 2010 …

The Effect Of Perturbation-Based Balance Training And Conventional Intensive Balance Training On Reactive Stepping Ability In Individuals With Incomplete Spinal Cord Injury Or Disease: A Randomized Clinical Trial, Janelle Unger, Katherine Chan, Jae W Lee, B Catharine Craven, Avril Mansfield, Mohammad Alavinia, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.

Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.

Design: Randomized clinical trial.

Setting: Tertiary SCI/D rehabilitation center.

Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.

Methods: Participants were randomly allocated …

Corticospinal Activity During A Single-Leg Stance In People With Chronic Ankle Instability, Masafumi Terada, Kyle B. Kosik, Ryan S. Mccann, Colin Drinkard, Phillip A. Gribble

Athletic Training and Clinical Nutrition Faculty Publications

PURPOSE: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls.

METHODS: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.

RESULTS: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to …

Immediate Effects Of Anodal Transcranial Direct Current Stimulation On Postural Stability Using Computerized Dynamic Posturography In People With Chronic Post-Stroke Hemiparesis, Jing Nong Liang, Leonard Ubalde, Jordon Jacklin, Peyton Hobson, Sara Wright-Avila, Yun-Ju Lee

Physical Therapy Faculty Publications

Postural stability is commonly decreased in individuals with chronic post-stroke hemiparesis due to multisystemic deficits. Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability, inducing neuroplastic changes to the targeted cortical areas and has been suggested to potentially improve motor functions in individuals with neurological impairments. The purpose of this double-blinded, sham-controlled study was to examine the acute effects of anodal tDCS over the lesioned motor cortex leg area with concurrent limits of stability training on postural control in individuals with chronic post-stroke hemiparesis. Ten individuals with chronic post-stroke hemiparesis received either anodal or sham tDCS …

Distality Of Attentional Focus And Its Role In Postural Balance Control, Christian Kupper, Karen Roemer, Elizabeth Jusko, Karen Zentgraf

All Faculty Scholarship for the College of Education and Professional Studies

The role of attentional focusing in motor tasks has been highlighted frequently. The “internal–external” dimension has emerged, but also the spatial distance between body and attended location. In two experiments, an extended attentional focus paradigm was introduced to investigate distality effects of attentional foci on balance performance. First, the distality of the coordinates of the point of focus was varied between a proximal and distal position on an artificial tool attached to the body. Second, the distance of the displayed effect on the wall was varied between a 2.5 and 5 m condition. Subjects were instructed to focus on controlling …

An Evaluation Of Postural Control And Balance After Anterior Cruciate Ligament Reconstruction, Kathryn Lucas

Theses and Dissertations--Rehabilitation Sciences

Over 100,000 anterior cruciate ligament reconstructions (ACLR) occur annually in the United States, with one in four individuals sustaining a second injury within the first two years after reconstruction. Due to the proprioceptive nature of the anterior cruciate ligament, the lack of regaining postural control and balance are likely large contributors to the rate of secondary injuries after ACLR. Recent literature has identified cerebral changes after anterior cruciate ligament injury and surgery, likely due to altered sensation and feedback loops. However, no study thus far has investigated the neurological feedback loops that may place this group at higher risk of …

Training Postural Control With Eyes Closed Vs. Eyes Open And Effects On Postural Control Improvement, Mark D. Ulbricht

Cal Poly Humboldt theses and projects

Introduction: Ankle sprains are one of the more common injuries in an athletic population. Postural control training can be used in prevention and rehabilitation for ankle sprains. When used preventively postural control training can decrease the risk of sustaining an ankle sprain by 38% (McGuine & Keene, 2006). There are a variety of postural control training programs all emphasizing different aspects of postural control, such as eyes closed, or eyes open situations. Training protocols with either eyes closed or eyes open have been shown to improve both static and dynamic postural control (Zech et al., 2010). The purpose of this …

A 4-Week Multimodal Intervention For Individuals With Chronic Ankle Instability: Examination Of Disease-Oriented And Patient-Oriented Outcomes, Cameron J. Powden, Johanna M. Hoch, Beth E. Jamali, Matthew C. Hoch

Rehabilitation Sciences Faculty Publications

Context Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention have not been evaluated for their effects on a multidimensional profile of health.

Objective To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI.

Design Controlled laboratory study.

Setting Laboratory.

Patients or Other Participants Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, …

Anticipatory Postural Adjustments And Spatial Organization Of Motor Cortex: Evidence Of Adaptive Compensations In Healthy Older Adults, Jo Armour Smith, Beth E. Fisher

Physical Therapy Faculty Articles and Research

During anticipated postural perturbations induced by limb movement, the central nervous system generates anticipatory postural adjustments (APAs) in the trunk and hip musculature to minimize disturbances to equilibrium. Age-related changes in functional organization of the nervous system may contribute to changes in APAs in healthy older adults. Here we examined if altered APAs of trunk/hip musculature in older adults are accompanied by changes in the representation of these muscles in motor cortex. Twelve healthy older adults, 5 with a history of falls and 7 nonfallers, were compared with 13 young adults. APAs were assessed during a mediolateral arm raise task …

Dynamical Properties Of Postural Control In Obese Community-Dwelling Older Adults, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart, John Lach, Dong Sam Ha, Karen A. Roberto, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least …

Baseline Postural Control Measures: An Indicator For Increased Injury Frequency Following Sports Related Concussion, Emily Belson

Electronic Theses and Dissertations

INTRODUCTION: An increase in acute lower extremity (LE) injuries have been observed in athletes following sports-related concussion.^{1, 2, 3} It has been suggested that lingering postural control deficits as a result of concussive injury, may play a role in the increased prevalence of injury.¹ PURPOSE: To investigate the relationship between baseline postural control metrics (Root Mean Square; Peak Excursion Velocity; Sample Entropy) and acute LE injury frequency in NCAA Division I student athletes (SA) with a previous history of concussion. METHODS: Eighty-four NCAA Division I SA were selected from a single university, 42 SA with a previous history …

Effect Of Whole Body Vibration On Center Of Mass Movement In Children And Young Adults, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) has acute effects on postural control strategy. The degree of impact depends on the amplitude, frequency, and duration of WBV, and the difficult level of balance task as well as the reliability of sensory information to the individual [1, 2, 3]. Healthy young adults can return to the baseline level of postural sway for a simple balance task within 20 minutes after repeated exposure to WBV [4]. Little is known about the acute and residual effects of WBV on the center-of-mass (COM) movement after a single bout of WBV. This study aimed to understand the COM …

Effect Of Stance Symmetry On Perturbation-Induced Protective Stepping In Persons Poststroke And Controls, Katherine M. Martinez

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem Statement: Stepping is a common strategy after a perturbation. Stroke survivors display a predilection for stepping with non-paretic leg. Insight into induced stepping between stroke survivors and age-matched control may guide our understanding for reactive postural control training post stroke. Purpose: To investigate the difference in perturbation-induced stepping between chronic stroke survivors and age-matched controls at three phases of the stepping response: preparation, execution, and landing and association with clinical outcome measures. Procedure: Twenty-one community-dwelling chronic stroke survivors (mean age 59y/o ±13yrs) and 17 age- and gender-matched controls (mean age 54.4y/o ±17yrs) completed this study. Clinical measures of gait, …

Health-Related Quality Of Life In Individuals With Chronic Ankle Instability, Megan N. Houston, Bonnie L. Van Lunen, Matthew C. Hoch

Rehabilitation Sciences Faculty Publications

Context: Individuals with chronic ankle instability (CAI) have reported decreased global and regional function. Despite the identification of functional deficits in those with CAI, more research is required to determine the extent to which CAI influences the multidimensional profile of health-related quality of life.

Objective: To determine whether global, regional, and psychological health-related outcomes differ between individuals with and without CAI.

Design: Case-control study.

Setting: Laboratory.

Patients or Other Participants: Twenty-five participants with CAI (age = 21.9 ± 2.5 years, height = 170.8 ± 8.6 cm, mass = 69.8.0 ± 11.7 kg) were sex- and limb-matched to 25 healthy participants …

Are Scores On The Ppt Useful In Determination Of Risk Of Future Falls In Individuals With Dementia?, Mary K. Farrell, Richard A. Rutt, Michelle M. Lusardi, Ann K. Williams

All PTHMS Faculty Publications

Individuals with dementia or Alzheimer’s disease (AD), exhibit both a progressive decline in cognitive function and accumulating difficulty with physical function.¹ As cognitive impairment begins, individuals will initially demonstrate difficulties with short-term memory and with instrumental activities of daily living. As the dementia progresses, individuals will increasingly demonstrate difficulties with long-term memory, communication, and basic activities of daily living.

Mobility, Balance, And Falls In Persons With Multiple Sclerosis, Jacob J. Sosnoff, Michael J. Socie, Morgan K. Boes, Brian M. Sandroff, John H. Pula, Yoojin Suh, Madeline Weikert, Steven Morrison, Robert W. Motl

Rehabilitation Sciences Faculty Publications

Background: There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS (PwMS). This investigation assessed the relation between demographic, clinical, mobility and balance metrics and falls history in persons with multiple sclerosis (MS).

Methods: 52 ambulatory persons with MS (PwMS) participated in the investigation. All persons provided demographic information including fall history over the last 12 months. Disease status was assessed with Expanded Disability Status Scale (EDSS). Walking speed, coordination, endurance and postural control were quantified with a multidimensional mobility battery.

Results: Over 51% of the participants …

The Relationship Of Cervical Joint Position Error To Balance And Eye Movement Disturbances In Persistent Whiplash, Julia Treleaven, Gwendolen Jull, Nancy Low Choy

Nancy Low Choy

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The …

Phenomena Correlated To Stroke Patients With Pusher Syndrome, Hung-Che Wang, Ling-Fu Meng

Rehabilitation Practice and Science

Stroke patients who cannot maintain a balanced sitting or standing position fall toward one specific side. There can be a strong tendency to actively use non-hemiplegic extremities to push the body away from the sound side. As well, patients may resist any attempt to correct their postures and finally fall toward the hemiplegic side. This falling asymmetry phenomenon has been termed ”Pusher syndrome.” The syndrome often occurs coincident with frequent lapses in consciousness, poor motor control, impaired sensory status, spatial neglect, and limited perceptual function. Recent observations have indicated that Pusher syndrome is strongly related to body orientation deficit and …

Smooth Pursuit Neck Torsion Test In Whiplash Associated Disorders - Relationship To Self Reports Of Neck Pain And Disability, Dizziness And Anxiety, Julia Treleaven, Gwendolen Jull, Nancy Low Choy

Nancy Low Choy

Objective:
The smooth pursuit neck torsion test is thought to be a measure of neck afferent influence on eye movement control and is useful in assessing subjects with whiplash, especially those complaining of dizziness. Nevertheless, it is not known whether impairments identified relate only to abnormal cervical afferentation or are influenced by levels of anxiety or neck pain.

Design:
A prospective, 3-group, observational design.

Subjects:
One hundred subjects with persistent whiplash (50 complaining of dizziness, 50 not complaining of dizziness) and 50 healthy controls.

Methods:
The smooth pursuit neck torsion test was performed and analysed taking into account subjects' reported …

Standing Balance In Persistent Wad – Comparison Between Subjects With And Without Dizziness, Julia Treleaven, Gwendolen Jull, Nancy Low Choy

Nancy Low Choy

Objective:
Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes.

Design:
A prospective, 3 group, observational design.

Subjects:
100 subjects with persistent whiplash associated disorders, 50 complaining of dizziness, 50 not complaining of dizziness and 50 healthy controls.

Methods:

The Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance. The sway trace was analysed using wavelet analysis.

Conclusion:
The results …