Medicine and Health Sciences Commons^™

The Influence Of Divided Attention On Walking Turns: Effects On Gait Control In Young Adults With And Without A History Of Low Back Pain, Jo Armour Smith, James Gordon, Kornelia Kulig

Physical Therapy Faculty Articles and Research

The cognitive control of gait is altered in individuals with low back pain, but it is unclear if this alteration persists between painful episodes. Locomotor perturbations such as walking turns may provide a sensitive measure of gait adaptation during divided attention in young adults. The purpose of this study was to investigate changes in gait during turns performed with divided attention, and to compare healthy young adults with asymptomatic individuals who have a history of recurrent low back pain (rLBP). Twenty-eight participants performed 90° ipsilateral walking turns at a controlled speed of 1.5 m/s. During the divided attention condition they …

Rehabilitation Of An Injured Golden Eagle (Aquila Chrysaetos): A Case Study, Fida Muhammad Khan, Fakhar-I- Abbas, Abu Ul Hassan Faiz

Journal of Bioresource Management

Habitat destruction and anthropogenic activities cause wild birds to migrate towards urban areas in search of food and sometimes nesting in high-roof buildings, where they are caught by local people using different techniques and are further used for hunting or recreational purposes. An injured Golden Eagle (Aquila chrysaetos) was found entangled in bushes near the vicinity of Balkasar Research Complex, Chakwal, Pakistan. After complete physical examination, a wound on the right wing and closed leg fracture was diagnosed. The successful treatment was done by anti-parasitic and anti-bacterial drugs with careful monitoring. Splint was adjusted after aligning the fractured …

Linking Spinal Cord Injury Rehabilitation Between The World Wars: The R. Tait Mckenzie Legacy., John F. Ditunno, Jr

Department of Rehabilitation Medicine Faculty Papers

Spinal cord injury (SCI) medicine emerged after World War II due to mass casualties, which required specialized treatment centers. This approach to categorical care, however, was first developed during World War I, led by pioneers R. Tait McKenzie and George Deaver, who demonstrated that soldiers disabled by paralysis could return to society through fitness/mobility, recreational and vocational training. McKenzie, a Canadian and the first professor of physical therapy in the US, influenced Deaver and military physicians in Britain, Canada, and the U.S. with his achievements and publications. Although early mortality from SCI was high, advances in the treatment of skin …

Culture Of Mobility, Beth Colborn, Dpt, Helene Daly, Msn, Rn, Kathleen Hilbert, Rn, Msn, Cm, Gordon R. Reeves, Md, Jessica Shank, Pt, Mpt, Elizabeth Singh, Dpt, Lisa Wus, Dnp, Rn, Crnp, Pccn-Cmc

Department of Rehabilitation Medicine Posters

Objectives

•Create an interdisciplinary approach to patient mobility and functional independence

•Provide education and support to lead a culture of mobility

•Develop a system that reduces immobility related adverse outcomes and promotes overall patient well-being

•Utilize evidence based practice to create a program that will decrease variation in patient care in order to optimize hospital based outcomes

Orthotic Scar Management For Hands., Lisa Lepage Otr/L

Department of Medicine

No abstract provided.

Impacts Of Exercise On Functional Ability Of Recovering Gbs Patients: An Integrative Literature Review, Yasmin Sheriff

Grace Peterson Nursing Research Colloquium

This integrative literature review aimed to investigate the impacts exercise has on functional ability of GBS patients in recovery.

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Use Of Methylprednisolone Sodium Succinate, Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul A. Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory W. Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark R. Kotter, Shekar N. Kurpad, Brian Kwon, Ralph J. Marino, Allan R. Martin, Eric M. Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve Tsai, Alexander R. Vaccaro, Albert Yee, James S. Harrop

Department of Rehabilitation Medicine Faculty Papers

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions …

Type And Timing Of Rehabilitation Following Acute And Subacute Spinal Cord Injury: A Systematic Review, Anthony S. Burns, Ralph J. Marino, Sukhvinder Kalsi-Ryan, James W. Middleton, Lindsay A. Tetreault, Joseph R. Dettori, Kathryn E. Mihalovich, Michael G. Fehlings

Department of Rehabilitation Medicine Faculty Papers

Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies, including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated …

The Effectiveness Of Cervical Traction And Exercise In Decreasing Neck And Arm Pain For Patients With Cervical Radiculopathy: A Critically Appraised Topic, Shelby Baez, Johanna M. Hoch, Timothy L. Uhl

Physical Therapy Faculty Publications

Clinical Question:

Is there evidence to suggest intermittent cervical traction with cervical and scapular strengthening exercises is more effective in decreasing neck and arm pain when compared with cervical and scapular strengthening exercises alone in nonoperative patients with cervical radiculopathy?

Clinical Bottom Line:

There is currently inconsistent, high-quality evidence that suggests that the use of intermittent cervical traction in addition to strengthening exercises is more effective at decreasing pain in nonoperative patients with cervical radiculopathy when compared with strengthening alone. Future research should continue to examine long-term outcomes associated with cervical radiculopathy patients who use intermittent cervical traction as an …

Patient Education Using The Cognitive Apprenticeship Model: A Study For Rehabilitation Specialists, Paul M. Dye

Student Dissertations

Quality patient education has long been a concern for both patients and health care providers. While many clinicians support the importance of patient education, it is not known which theoretical education model supports best practice. The purpose of this study is to determine the effectiveness of the Cognitive Apprenticeship Model (CA) when compared to traditional patient education. There were 34 individuals receiving therapy who volunteered to be in a treatment group that received patient education using the CA model. There were 24 individuals who were assigned to a control group who received traditional patient education.

While not all of the …

The Effects Of Frequent Smartphone Use On Children’S Upper Posture And Pulmonary Function, Asma Alonazi

Loma Linda University Electronic Theses, Dissertations & Projects

Children are experiencing an increase in sedentary lifestyle as a result of the rising utilization of technology, i.e. smartphones. With the prolonged use of smartphones, increased concerns have been raised regarding constant neck flexion, neck movements limitation, and decreases in pulmonary function due to potential changes in spinal posture. Therefore, the purpose of this research thesis was to evaluate changes in craniovertebral angles (CVA), cervical range of motion (ROM), and pulmonary function among boys and girls 8 to 13 years of age who use smartphones. A cross-sectional study was conducted on a sample of 50 participants (24 boys and 26 …

The Effects Of Wearing Headscarves On Cervical Spine Proprioception And Range Of Motion, Samiah Alqabbani

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Wearing the headscarf is a part of an essential religious practice by females in Islamic cultures. Regular wear of the headscarf might have an influence on cervical proprioception and range of motion (ROM). The cervical spine is unique in providing multidirectional movement as well as providing the sense of awareness of movement of the head and neck in space. Impairments in cervical mobility and proprioception have been reported in subjects with whiplash-associated disorder as well as subjects having neck pain. Objectives: 1) To determine the effects of wearing the headscarf on cervical spine ROM and joint position error …

Infection Prevention Strategies In Cardiac Rehabilitation [1]—A Behavioral Intervention For Patients [2], Wendy Bjerke

Exercise Science Faculty Publications

Background: Healthcare Acquired Infections (HAI) result in over 100 thousand deaths each year with one third of these deaths preventable via behaviors such as hand washing among health care providers in inpatient settings. Less research has been conducted in outpatient exercise settings such as cardiac rehabilitation (CR) among patients. Purpose: The purpose of this study was to examine the effectiveness of HAI prevention strategies in a CR setting among patients. Methods: Observations of the frequency of hand washing among CR patients pre and post four HAI strategies including provision of HAI education and signs, hand washing demonstrations, a HAI prevention …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Type And Timing Of Rehabilitation, Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James Harrop, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander R. Vaccaro, Jefferson R. Wilson, Albert Yee, Anthony S. Burns

Department of Neurosurgery Faculty Papers

Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on …

Efficacy And Safety Of Methylprednisolone Sodium Succinate In Acute Spinal Cord Injury: A Systematic Review, Michael G. Fehlings, Jefferson R. Wilson, James S. Harrop, Brian Kwon, Lindsay A. Tetreault, Paul M. Arnold, Jeffrey M. Singh, Gregory W.J. Hawryluk, Joseph R. Dettori

Department of Neurosurgery Faculty Papers

Study Design: Systematic review and meta-analysis. Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI). Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated …

A Clinical Practice Guideline For The Management Of Acute Spinal Cord Injury: Introduction, Rationale, And Scope, Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Brian K. Kwon, Anthony S. Burns, Allan R. Martin, Gregory Hawryluk, James S. Harrop

Department of Neurosurgery Faculty Papers

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of …

International Society Of Sports Nutrition Position Stand: Nutrient Timing, Chad M. Kerksick, Shawn Arent, Brad J. Schoenfeld, Jeffrey R. Stout, Bill Campbell, Colin D. Wilborn, Lem Taylor, Doug Kalman, Abbie E. Smith-Ryan, Richard B. Krieder, Darryn Willoughby, Paul J. Arciero, Trisha A. Vandusseldorp, Michael J. Ormsbee, Robert Wildman, Mike Greenwood, Tim N. Ziegenfuss, Alan A. Aragon, Jose Antonio

Publications and Research

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review regarding the timing of macronutrients in reference to healthy, exercising adults and in particular highly trained individuals on exercise performance and body composition. The following points summarize the position of the ISSN: 1. Nutrient timing incorporates the use ofmethodical planning and eating ofwhole foods, fortified foods and dietary supplements. The timing of energy intake and the ratio of certain ingestedmacronutrientsmay enhance recovery and tissue repair, augmentmuscle protein synthesis (MPS), and improvemood states following high-volume or intense exercise. 2. Endogenous glycogen stores are maximized by following …

Physiological Response To Firefighting Activities Of Various Work Cycles Using Extended Duration And Prototype Scba, Richard M. Kesler, Ipek Ensari, Rachel E. Bollaert, Robert W. Motl, Elizabeth T. Hsiao-Wecksler, Karl S. Rosengren, Bo Fernhall, Denise L. Smith, Gavin P. Horn

Exercise Science Faculty Research and Publications

Firefighters’ self-contained breathing apparatus (SCBA) protects the respiratory system during firefighting but increases the physiological burden. Extended duration SCBA (>30 min) have increased air supply, potentially increasing the duration of firefighting work cycles. To examine the effects of SCBA configuration and work cycle (length and rest), 30 firefighters completed seven trials using different SCBA and one or two bouts of simulated firefighting following work cycles common in the United States. Heart rate, core temperature, oxygen consumption, work output and self-reported perceptions were recorded during all activities. Varying SCBA resulted in few differences in these parameters. However, during a second …

Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017, Caroline Komanecky, Peter Sacci, Danielle Mcfadden, Nuriya Neumann, Michaela Scotten, Melissa Murphy

Department of Occupational Therapy Posters and Presentations

No abstract provided.

Ventilation And Neurochemical Changes During Μ-Opioid Receptor Activation Or Blockade Of Excitatory Receptors In The Hypoglossal Motor Nucleus Of Goats, Thomas M. Langer, Suzanne E. Neumueller, Emma Crumley, Nicholas J. Burgraff, Sawan Talwar, Matthew R. Hodges, Lawrence Pan, Hubert V. Forster

Physical Therapy Faculty Research and Publications

Neuromodulator interdependence posits that changes in one or more neuromodulators are compensated by changes in other modulators to maintain stability in the respiratory control network. Herein, we studied compensatory neuromodulation in the hypoglossal motor nucleus (HMN) after chronic implantation of microtubules unilaterally (n = 5) or bilaterally (n = 5) into the HMN. After recovery, receptor agonists or antagonists in mock cerebrospinal fluid (mCSF) were dialyzed during the awake and non-rapid eye movement (NREM) sleep states. During day studies, dialysis of the µ-opioid inhibitory receptor agonist [d-Ala², N-MePhe⁴, Gly-ol]enkephalin (DAMGO; 100 µM) decreased …

Health Promotion And Wellness Strategies And Self-Regulation Interventions For Occupational Therapy Assistant Program Graduates Preparing For The Nbcot Exam, Marcia Hamilton

Occupational Therapy Collection

New graduates of Occupational Therapy Assistant (OTA) Programs are challenged with the preparation and successful completion of the National Board for Certification in Occupational Therapy (NBCOT) Certified Occupational Therapy Assistant (COTA) examination. The threat of not passing this exam is intensified due to the cost of the exam and lack of provisional licensing. Anecdotal experience of faculty in an OTA Program supports concern for new graduates as they report feelings of distress and anxiety, as they enter the one- to two-month period prior to the exam. An occupational role shift must occur during this transitional period, as the new graduates …

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.

The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

Evidence Of Energetic Optimization During Adaptation Differs For Metabolic, Mechanical, And Perceptual Estimates Of Energetic Cost, Natalia Sánchez, Sungwoo Park, James M. Finley

Physical Therapy Faculty Articles and Research

The theory that the sensorimotor system minimizes energetic cost during locomotion has long been supported by both computational models and empirical studies. However, it has yet to be determined if the behavior to which people converge when exposed to a novel perturbation during locomotion is also energetically optimal. We address this issue in the context of adaptation to walking on a split-belt treadmill, which can impose a left-right asymmetry in step lengths. In response to this asymmetry, participants gradually adjust their foot placement to adopt steps of equal length. Here, we characterized metabolic, mechanical, and perceptual estimates of energetic cost …

Enhancing Value-Based Healthcare With Reconstructability Analysis: Predicting Risk For Hip And Knee Replacements, Cecily Corrine Froemke

Dissertations and Theses

Legislative reforms aimed at slowing growth of US healthcare costs are focused on achieving greater value, defined specifically as health outcomes achieved per dollar spent. To increase value while payments are diminishing and tied to individual outcomes, healthcare must improve at predicting risks and outcomes.

One way to improve predictions is through better modeling methods. Current models are predominantly based on logistic regression (LR). This project applied Reconstructability Analysis (RA) to data on hip and knee replacement surgery, and considered whether RA could create useful models of outcomes, and whether these models could produce predictions complimentary to or even stronger …

Conservative Treatment For Patients With Suspected Slap Tears: A Case Series, Stephanie D. Moore-Reed, Kelley A. Seekins, W. Ben Kibler, Aaron D. Sciascia, Timothy L. Uhl

Physical Therapy Faculty Publications

Objective: Outcome following non-operative management of superior labral anterior to posterior (SLAP) lesions has been under reported with little empirical data demonstrating the effectiveness of conservative treatment. Material and Methods: 10 patients, 5 matched pairs, presenting with symptoms consistent with a SLAP lesion performed a standardized phased rehabilitation program completing patient reported outcome (PRO) and pain measures before and following rehabilitation. Physical therapy notes and home exercise logs were reviewed and all exercises were recorded and coded using the phased rehabilitation protocol as a guide. At followup, patients were divided into two groups; responders and non-responders to treatment based on …

Lower Extremity Motor Impairments In Ambulatory Chronic Hemiparetic Stroke: Evidence For Lower Extremity Weakness And Abnormal Muscle And Joint Torque Coupling Patterns, Natalia Sánchez, Ana Maria Acosta, Roberto Lopez-Rosado, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Although global movement abnormalities in the lower extremity poststroke have been studied, the expression of specific motor impairments such as weakness and abnormal muscle and joint torque coupling patterns have received less attention. We characterized changes in strength, muscle coactivation and associated joint torque couples in the paretic and nonparetic extremity of 15 participants with chronic poststroke hemiparesis (age 59.6 ± 15.2 years) compared with 8 age-matched controls. Participants performed isometric maximum torques in hip abduction, adduction, flexion and extension, knee flexion and extension, ankle dorsi- and plantarflexion and submaximal torques in hip extension and ankle plantarflexion. Surface electromyograms (EMGs) …