Medicine and Health Sciences Commons^™

The Effects Of Chin-Tuck Position In Stroke Patient With Dysphagia Evaluated By Fiberoptic Endoscopy, Yuyu Chen, Tienwen Chen, Maohsiung Huang

Rehabilitation Practice and Science

Background and Purpose: Dysphagia is a frequent symptom after stroke. Dysphagia increases the risk of aspiration pneumonia, malnutrition, and is associated with poor prognosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is a suitable method for dysphagia assessment after acute stroke. Chin-tuck position has been used in dysphagia patients to prevent aspiration during swallowing. But the combined application of these promising modalities has rarely been studied. We aimed to evaluate the effects of chin-tuck position in stroke patient with dysphagia evaluated by fiberoptic endoscopy. Methods: A total of 34 consecutive patients with first stroke were enrolled. FEES after swallowing was done …

Social Support Status In Informal Caregivers Of Stroke Patients, Yanyuh Lee, Yeehwa Wu, Ihsuan Chen, Kuchou Chang, Yuching Huang, Jenwen Hung

Rehabilitation Practice and Science

Objective: Informal caregivers play an important role in post-stroke care. In the present study, we aimed to investigate the social support status over an 18-month duration; the relationship between health status and social support level; and the predictors of low social support status in informal caregivers of stroke patients. Methods: We recruited eligible inpatients with first-ever ischemic stroke and their informal caregivers from a tertiary referral teaching hospital. The social support rating scale (SSRS) of the caregivers was determined at 3, 16, and 18 months after stroke onset. Beck depression inventory (BDI) as well as the physical and mental composite …

Comparison Of The Effects Of Prolotherapy And Traditional Physical Therapy In Low Back Pain Patients With Lumbosacral Transitional Vertebra, Weihan Chang, Shihwei Chou, Chienhung Chen, Chihkuan Wu, Katie P. Wu, Yinchou Lin

Rehabilitation Practice and Science

A lumbosacral transitional vertebra (LSTV) is a congenital musculoskeletal abnormality with a higher incidence in patients with low back pain as to the normal population. Such finding implicates that an altered mechanics caused by a transitional vertebra may contribute to pain generation. In cadavers with an LSTV, the iliolumbar ligament at the level immediately above the transitional vertebra was thinner and weaker than it was for cadavers without an LSTV. This ligament of LSTV is vulnerable to sprains in terms of structural and biomechanical alterations and may be the target of treatment. Twenty-two patients with chronic low back pain in …

Assessment Of Visual Dysfunction In A Patient With Right Occipital Infarct, Li-Ting Tsai, Yu-Chin Su, William H.A. Beaudot, Yun-Hsiang Yang

Rehabilitation Practice and Science

Purpose: This study describes a patient with multiple visual impairments following right occipital infarction in the posterior cerebral artery (PCA) territory. The earliest stage of cortical processing of visual information occurs in the occipital lobe, so damage to this lobe causes not only visual field deficits but also other forms of visual problems. However, few cases of this sort have previously been reported in the literature. casereport: A 54-year-old female suffered from a progressive throbbing headache over the right occipital area for 2 weeks. Blurred vision and left hemianopia were found, and brain magnetic resonance imaging revealed cerebral infarction over …

Exploring End User Experience: How Can We Achieve Lifelong Engagement With Physical Activity Tracking Devices?, Mohammed Karim Impelee

Masters Theses/Capstone Projects

Activity tracking devices provide biofeedback information and encourage people to be active, however, their long-term usage has been problematic. This study explored the theory of reinforcement techniques and the theory of self- determination to enhance long-term usage of activity tracking devices.

A sample of 43 people was surveyed to examine their experience with activity tracking devices. A multi-regression analysis demonstrated significant results(R square=71.6% Sig level=0.012 N=43). The result indicates how individuals with different orientations likely to perceive the supportiveness of their devices and how likely they were to continue using or stop using their devices. Conclusion: understanding the principles of …

Use Of A Task-Oriented Approach In The Physical Therapy Management Of A Patient Following A Posterior Inferior Cerebellar Artery Stroke: A Case Report, Erika Derks

Case Report Papers

Background and Purpose: Stroke is the leading cause of long term disability in the United States. Despite the prevalence of stroke, there is minimal research on physical therapy interventions for patients with cerebellar stroke. The purpose of this case report is to describe a multidimensional intervention program for a patient following a cerebellar stroke, emphasizing a task-oriented approach and motor learning principles. Case Description: The patient was a 78-year-old female who had a right posterior inferior cerebellar artery stroke. She received daily physical therapy for four and a half weeks in the acute rehabilitation setting. The examination revealed deficits in …

An Online Approach To Interprofessional Education, E. Adel Herge, Otd, Otr/L, Faota, Amber E. King, Pharmd, Bcps

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Despite increasing interest in providing interprofessional education (IPE) opportunities for health profession students, the logistics of scheduling and integrating diverse curriculums remain challenging. Several models to address these potential barriers have been proposed and utilized (Blue et al, 2010). Faculty from three colleges within Thomas Jefferson University developed an asynchronous online interprofessional course as one solution to overcome logistical barriers to IPE.

Interprofessional Grand Rounds is offered to third year pharmacy students and second year occupational therapy (OT) students in the fall semester. The course utilizes a variety of learning activities to evaluate the influence of current public health and …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

Autism Spectrum Disorder: A Case Study Of Mikey, Gabrielle Lober

Honors Theses

This paper describes Autism Spectrum Disorder (ASD) including diagnostic criteria, suspected causes, prevalence, comorbidities, and influences on client factors. A hypothetical case study is presented to give readers an illustration of what someone with ASD might look like. Possible treatment based on evidence and selected frame of references will be given for the hypothetical client. This paper is not all inclusive of the role of occupational therapy in the treatment of Autism Spectrum Disorder, but gives an illustrative example.

The Effects Of Neuromobilization Combined With Posture Training In The Management Of A Patient With Cervical Radiculopathy: A Case Report, Courtney Naimi

Case Report Papers

Background and Purpose: Management of cervical radiculopathy can include cervical traction, neural mobilization, manual therapy, and therapeutic exercise, whereas management of lateral epicondylitis can include eccentric tendinopathy management, manual therapy, and therapeutic exercise. Some evidence exists discussing neuromobilization for the management of axial diagnoses. However, there is sparse literature describing neuromobilization for management of both the presence of right C7, C8 radiculopathy and contralateral lateral epicondylitis. Therefore, the purpose of this case report is to discuss the outcomes of neuromobilization techniques for a patient presenting with right C7, C8 cervical radiculopathy with contralateral lateral epicondylitis. Case Description: A 64-year-old male …

Use Of Core Stabilization Exercise And Medical Exercise Therapy In The Treatment Of A Patient With Chronic Post Partum Low Back Pain: A Case Report, Zachary Chaloner, Kirsten Buchanan

Case Report Posters

Low back pain and lumbar hyper-mobility are common during and after pregnancy. Chronic postpartum low back pain (LBP) can be difficult to manage. Core stabilization exercises (CSE) have been shown to improve function and reduce pain in patients with chronic LBP due to lumbar instability. Medical Exercise Therapy (MET) has shown good outcomes in reducing pain in patients with LBP but has not been thoroughly investigated in the treatment of chronic post partum LBP. There is limited research reporting the use of a combined treatment protocol utilizing CSE and MET in the treatment of chronic LBP in postpartum women. The …

The Use Of Manual Therapy And Strengthening Exercises To Improve Plantarflexion Strength And Mobility Following Achilles Tendon Repair: A Case Report, Jason Glikman

Case Report Papers

Background and Purpose: The incidence of Achilles tendon ruptures is 1 in 10,000 per year, mostly affecting 30 to 50 year old males. These ruptures occur from either strong eccentric or concentric contractions of the gastrocnemius/soleus complex during acceleration or deceleration. Impact motions are common causes of this tendon ruptures. Neglected Achilles tendon ruptures occur when 4 weeks pass before treatment. This case report describes the clinical management of a patient with a neglected Achilles tendon rupture with global scar tissue formation due to a 3-month time period between injury and surgical repair, followed by a further 3-month time period …

Multimodal Physical Therapy Management Of A Patient With Unilateral Neglect Post-Stroke In An Outpatient Setting: A Case Report, Meghan Riley

Case Report Papers

Background and Purpose: Unilateral neglect (ULN) syndrome negatively affects recovery post-stroke and is often associated with falls, longer stays in rehabilitation, and the need for more assistance at discharge. Typical physical therapy treatments include voluntary trunk rotation, visual scanning exercises, mirror therapy, hemispheric activation, sensory awareness training, and lower extremity loading but the efficacy of these treatments is still unclear. The purpose of this case report is to describe multimodal physical therapy (PT) management that includes common PT interventions to alleviate symptoms of ULN and report upon the outcomes of the various treatment methods for rehabilitation of neglect during functional …

Trunk Control And Standing Tolerance Of A Patient With Paraparesis As A Result Of Transverse Myelitis And Mycotic Aneurysm Rupture: A Case Report, Ashley Tomaswick

Case Report Papers

Background and Purpose: Transverse myelitis (TM) is a rare condition in which the spinal cord becomes inflamed resulting in pain, paraparesis or paraplegia, impaired sensation, and/or impaired autonomic function. Approximately two-thirds recover with mild to moderate symptoms, but one-third are left with severe and disabling symptoms. Cerebral mycotic aneurysm (CMA) rupture is a brain injury due to a burst artery resulting in diminished blood supply to the brain. There is literature on beneficial physical therapy (PT) intervention progressions following brain injury, such as bed mobility strategies and pre-gait activities, but there is little published on PT for impairments as a …

Use Of The Lower Extremity Functional Scale (Lefs) In A Patient After A First Metatarsophalangeal Joint Implant: A Case Report, Courtney Brinckman

Case Report Papers

Background and Purpose. The LEFS was initially designed as a functional outcome measure for patients with lower-extremity orthopedic conditions.1 While the LEFS has been used for a broad spectrum of lower-extremity pathologies, there is a paucity of research that investigates the use of LEFS in patients who have had a first MTP joint implant. The purpose of this case report was to investigate the use of LEFS in a patient with a right first MTP HemiCAP(®) joint implant. Case Description. The patient was a 56 year-old male with bilateral pes planus. Conservative treatment for 9 years did not decrease symptoms …

Application Of A Balance Training Program In A Patient With Charcot Marie Tooth Disease: A Case Report, Eduardo Pena

Case Report Papers

Background and Purpose: Charcot Marie Tooth Disease (CMT) is the most common progressive inherited neurological disorder1. Characteristics include muscle weakness and reduced sensation beginning in the distal lower extremities. Individuals with CMT have increased difficulty sensing and maintaining balance. There is minimal research on the effectiveness of balance training and outcome measures in this population. The RUSK Hospital Modified Romberg Protocol (RUSK MRP) is used as a balance-training program for patients with a neurological diagnosis, however no information is available on its effectiveness in CMT. The purpose of this case report was to investigate the effectiveness of the RUSK MRP …

Restoring Functional Mobility In A Patient With Delayed Onset Of Physical Rehabilitation Following A Hemorrhagic Stroke: A Case Report, Bettie Kruger

Case Report Papers

Background and Purpose: Hemorrhagic stroke accounts for 10% to 15% of all strokes and is associated with a high mortality rate. A decompressive craniectomy is a neurosurgical procedure to reduce intracranial pressure in order to minimize risk of mortality and disability. It has been suggested that early and frequent mobilization following stroke onset is optimal for motor recovery. The purpose of this case report is to provide a framework of sub-acute rehabilitation that facilitated motor recovery and functional mobility in a patient with delayed participation in physical therapy (PT) following a stroke. Case Description: A 54 year-old female underwent an …

The Use Of Postural Reeducation And Strengthening Exercises In The Reversal Of Functional Scoliosis: A Case Report, Cory Marcoux

Case Report Papers

Background and Purpose: There is a multitude of research regarding structural and idiopathic scoliosis, but very minimal literature about non-structural (functional) scoliosis and more importantly, how to treat it. The purpose of this case report was to examine the use of stretching, strengthening, and postural reeducation for a patient who presented with a non-structural scoliosis. Case Description: The patient was a 37-year-old female who underwent a left-sided lumbar discectomy at level L5/S1 following an acute onset of left foot-drop. The patient later presented with severe back pain and spasms from an infection of the disc at the surgical site that …

Acute Care Outcome Measures In A Patient Status-Post Right Total Knee Arthroplasty (Tka) Following A Left Tka Staged Five Weeks Apart: A Case Report, Stephanie Sanderson

Case Report Papers

Background and Purpose: Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures in the U.S. Thousands of people undergo TKA every year in hopes of improving their functional abilities and reducing their pain levels. The purpose of this case report was to document acute care outcome measures in a patient who underwent bilateral TKA staged five weeks apart and to assess the possible implications that a short staging period might have on the patient’s ability to recover. Case Description: The patient was a 58-year-old male who following a left TKA underwent a right TKA, secondary to …

Use Of Manual Therapy And Sport Specific Re-Training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report, Erika Lopez

Case Report Papers

Background and Purpose: Bilateral pedicle stress fractures are extremely rare, with few cases reported in the literature. The pedicle is known to be the second weakest point of the vertebra, has a short moment arm from the vertebral body, and can resist a large amount of cyclic shear forces.1 There have been several reports describing pedicle stress fracture in adolescent athletes.1 However, in those reports the fracture was usually associated with contralateral spondylolysis, and isolated pedicle fractures are rarely found. 1This case report details a conservative approach using manual therapy, Pilates exercises, and sport specific re-training in an adolescent sprinter …

A Progressive Physical Therapy Plan Of Care For A Patient With Charcot-Marie-Tooth Disease Following Myocardial Infarction: A Case Report, Paige Blasco

Case Report Papers

Background and Purpose: Charcot-Marie-Tooth disease (CMT) is a neuromuscular disease that leads to distal muscle atrophy, weakness, and sensory loss. Myocardial infarction (MI) is often a result of coronary artery disease, which has an incidence rate of 34.6% in men over 80. While rehabilitation practices for CMT and MI have been described separately, there is a paucity of research investigating physical therapy (PT) interventions for patients who have both health conditions. The purpose of this case report was to investigate the PT management of a patient with CMT following an acute MI in the acute and sub-acute care settings. Case …

Functional Mobility Management Of A Patient With Adult-Onset Hereditary Proximal Motor Neuropathy Following A Tibial Fracture: A Case Report, Timothy Lira

Case Report Papers

Background & Purpose: Adult-onset hereditary proximal motor neuropathy (AHPMN) is a subcategory of spinal muscular atrophy, caused by survival motor neuron gene mutation. This rare disease, affecting approximately 1 in 10,000 people, presents as proximal weakness and muscle wasting, more commonly in the lower extremities, in addition to gait unsteadiness and difficulty standing. Additionally, the lifetime risk of developing CHF is one in five; Since the diagnosis poses a risk factor for falling, it may increase the likelihood of falls. Regarding seniors over the age of 65, fall-related injuries increased from 49.4% to 58.8% between 2005 and 2013, accounting for …

Core Strengthening And Lower Extremity Flexibility; A Model For Physical Therapy Treatment Of Acute Nonspecific Low Back Pain: Case Report, Todd Wilde

Case Report Papers

Background & Purpose: Effective physical therapy treatment strategies are needed in order to improve outcomes for patients with low back pain. Current trends indicate that treatment effect size could be enhanced by implementing patient-specific management strategies based on examination findings (1, 2). The purpose of this report is to describe the physical therapy management and functional recovery of an individual with work-related acute nonspecific low back pain based on a treatment approach consisting of core strengthening and lower extremity flexibility. Case Description: The patient is a 51 year-old male with a one-month history of low back pain without radiculopathy secondary …

Clinical Reasoning And Intervention Selection For A Patient With Lower Extremity Weakness Following Acute Alcoholic Polyneuropathy: A Case Report, Sarah Uzel

Case Report Papers

Background and Purpose: Acute alcoholic polyneuropathy (AAP) can present with a variety of symptoms including paresthesia and paralysis. There is little literature relating to physical therapy management and interventions for a patient with AAP. It is unclear what constitutes the best medical management and physical therapy practices for these patients. The purpose of this case report was to describe the clinical reasoning behind interventions selected for a patient with AAP in the acute setting. Case Description: The patient was a 33 year old male, who was diagnosed with AAP after two days in acute care. Intervention during the first two …

Vestibular Rehabilitation For A 17-Year Old Female With Post-Concussion Symptoms: A Case Report, Elizabeth Mosley

Case Report Papers

Background: Post-concussion syndrome is defined as a group of symptoms occurring after a traumatic brain injury (TBI) that can persist for durations ranging from weeks to years. The Centers for Disease Control and Prevention estimates that 1.7 million Americans experience TBI annually. Vestibular rehabilitation has been shown to help alleviate common symptoms after concussions, such as dizziness, headaches and impaired balance. The purpose of this case report is to describe the physical therapy management of a patient with post-concussion symptoms two months post-injury. Case Description: The patient is a 17-year-old female with a history of concussion following a syncopal episode …

Functional Training To Reduce Fall Risk In A Patient Following Cancer Treatment: A Case Report, Kristin O'Kelly

Case Report Papers

Background and purpose: The National Cancer Institute reports that approximately 39.6% of individuals will be diagnosed with cancer during their lifetime. Due to the large percentage of Americans affected each year, multiple studies have looked at the long-term effects of cancer treatment and survivorship on physical function. Studies have demonstrated that over half of cancer survivors age 55 and over have fallen in the past year, possibly as a result of treatment and subsequent muscle weakness, difficulty with balance, and impaired walking. The purpose of this case report was to detail interventions aimed at these modifiable factors in a patient …

Gait Training, Strength Training, And Pain Management Of A 26 Year Old Female Recovering From A Multiple Sclerosis Exacerbation: A Case Report, Ellen Cox

Case Report Papers

Background and Purpose: Multiple Sclerosis can be a debilitating disease that affects millions of people. Exacerbations range from mild to very severe. Due to the inconsistent nature of multiple sclerosis, the most effective treatments are still unclear. The purpose of this case report was to document the findings of an individual, who suffered a severe multiple sclerosis exacerbation after a series of stressful life events. Case Description: This case report presents a 26 year old female with a known history of multiple sclerosis. This patient suffered an exacerbation and her level of function went from living independently to unable to …

The Effects Of Specific Training On Balance And Ambulation In A Patient With Stage Iv Glioblastoma: A Case Report, Matt Denning

Case Report Papers

Background and Purpose: A Diagnosis of stage IV Glioblastoma and its treatment often results in many impairments and functional limitations. This case report describes the effectiveness of strengthening, balance, and gait training activities measured by Berg Balance Scale (BBS) and ambulation distances on an individual 62 year old diagnosed with stage IV glioblastoma. The aim of this case study was to implement strengthening, balance, and gait training to improve balance and reduce risk of falls in a patient who had a diagnosis of stage IV glioblastoma, a metastatic brain tumor resulting in progressive neurological impairments. Case Description: A 62 year …

Use Of Complete Decongestive Therapy And A Task-Oriented Approach In Treating Secondary Lymphedema And Improving Ambulation In A Patient Following A Stroke: A Case Report, Snezhana Rudakova

Case Report Papers

Background and Purpose: Ninety percent of stroke survivors have some functional disability with mobility and paralysis of the extremities being a major impairment. A paralysis of the extremities can result in an ineffective muscle pumping action, which can lead to the development of lymphedema, further increasing difficulty with ambulation post stroke. The purpose of this case is to report the use of complete decongestive therapy for the treatment of lymphedema as part of a comprehensive treatment program consisting of a task-oriented approach to improve walking ability in a stroke survivor. Case Description: The patient was a 53 year old female …