Medicine and Health Sciences Commons^™

Using Concept Mapping To Develop A Human Rights Based Indicator Framework To Assess Country Efforts To Strengthen Rehabilitation Provision And Policy: The Rehabilitation System Diagnosis And Dialogue Framework (Resyst), Dimitrios Skempes, John L. Melvin, Per Von Groote, Gerold Stucki, Jerome Bickenbach

Department of Rehabilitation Medicine Faculty Papers

Background: Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to …

Integration Of Therapies In Autistic Children; A Survey Based In Karachi, Pakistan, Masnoon Akhter, Mussarat Ashraf, Adnan Ali, Irum Rizwan, Rehana Rehman

Department of Biological & Biomedical Sciences

A cross-sectional study was conducted from January to June 2016 on autistic children at the Autism Unit of Dow University of Health Sciences to compare speech therapy, occupational therapy and combination of both for rehabilitation of autistic children in the selected population. A total of 55 children with autism age range from 1-12 years of both gender and all ethnic groups were recruited. All data was analysed in IBM-SPSS version 23.0. Pearson chi-square test was used to determine association of type of therapy with the diagnosed age of child, gender, mode of delivery, history of vaccination and parent's education. Educated …

Bringing Employment First To Scale: Support Coordination Strategies That Impact Employment Outcomes And Services For Individuals Served By State Intellectual/Developmental Disabilities Agencies, Barbara Brent, Rie Kennedy-Lizotte, Mary Lee Fay, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Leadership from NASDDDS and ICI worked together to determine topics for a series of white papers on policies that influence employment outcomes for individuals with IDD. This white paper is the third in a series of five. It provides an overview of strategies that support coordinators, or case managers, use to influence employment outcomes for individuals with IDD who are receiving state funded services.

Bringing Employment First To Scale: Pushing The Integrated Employment Agenda: A Case Study Of Maryland’S High-Performing Employment System, Jean Winsor, Cady Landa, Allison C. Hall, Caro Narby, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

This brief summarizes data collected from key informants in Maryland about the state’s efforts to support integrated employment for people with intellectual and developmental disabilities (IDD). It highlights features that contribute to the effectiveness of Maryland’s collaborative structures that have resulted in the state’s success in achieving integrated employment outcomes for individuals with IDD across three state systems: IDD, vocational rehabilitation (VR), and education. Presentation of these features is organized by the seven elements of the Higher-Performing States Employment Framework. These elements have been found to be important in achieving higher rates of competitive integrated employment outcomes for people with …

Statedata: The National Report On Employment Services And Outcomes Through 2016, Jean Winsor, Jaimie Ciulla Timmons, John Butterworth, Alberto Migliore, Daria Domin, Agnes Zalewska, John Shepard, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Recent legislation and regulation governing Medicaid Home and Community-Based Services (HCBS), the Workforce Innovation and Opportunity Act of 2014 (WIOA), and settlement agreements between states and the U.S. Department of Justice are clarifying federal intent and paving the way to supporting opportunities for people with disabilities to have meaningful jobs in their communities. With an increasing emphasis on integrated employment and an Employment First philosophy, the nation is poised for transformation that could put Americans with disabilities on a path out of poverty and towards self-sufficiency. However, there remains a significant gap in employment rates between people with and without …

The Effect Of Telerehabilitation On Missed Appointment Rates, Lyn T. Covert, John T. Slevin, Jessica Hatterman

Neurology Faculty Publications

The purpose of this study was to examine the effect of telerehabilitation on missed appointment rates in a rehabilitation clinic. Clients fail to attend scheduled appointments for a variety of reasons. Unmet appointments represent a loss of financial support as well as diminished efficiency and capacity to provide services. Speech therapy utilizing multiple appointments is most difficult to maintain during a treatment regimen. This may cause individuals to miss appointments and therefore not achieve desired results. For this study, researchers utilized an intense speech therapy technique, the Lee Silverman Voice Treatment (LSVT®) to measure compliance with scheduled appointments. Participants were …

Experience Of Robotic Exoskeleton Use At Four Spinal Cord Injury Model Systems Centers, Allen W. Heinemann, Arun Jayaraman, Chaithanya K. Mummidisetty, Jamal Spraggins, Daniel Pinto, Susan Charlifue, Candy Tefertiller, Heather B. Taylor, Shuo-Hsiu Chang, Argyrios Stampas, Catherine L. Furbish, Edelle C. Field-Fote

Physical Therapy Faculty Research and Publications

Background and Purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility.

Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions.

Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used …

Sustaining Daily Management With Gemba Walks: A Scheduling Model, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL

At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11^th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria.

The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use …

Generalist Versus Specialist Nurses' Knowledge, Attitudes, And Behavioral Intentions Toward Promoting Pulmonary Rehabilitation For Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Correlational Study, Su-Er Guo, Hsueh-Chen Shen, Chizimuzo T. C. Okoli, Yen-Chi Liao, Kuen-Daw Tsai, Ming-Shian Lin, Hsin-Tien Hsu

Nursing Faculty Publications

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.

A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. …

Knee Extensor Fatigability During Different Resistance Exercise Protocols In Young And Old Adults, Jose Delgadillo

Master's Theses (2009 -)

Aging is associated with decreased muscle strength, power, and contraction velocity, and increased fatigability of the lower limb muscles during dynamic contractions. The aims of this thesis were to compare young in and old men and women in: (1) fatigability of the knee extensors for two types of dynamic fatiguing protocols that are the basis of resistance training protocols, and (2) the central and peripheral mechanisms of fatigue during the two types of dynamic fatiguing protocols. Twenty young (19-24, 22.2 ± 1.3 years, men = 10) and twenty old adults (64-85, 73.8 ± 5.4, men = 10) performed: two different …

Emotional Exhaustion, Depersonalization, And Feelings Of Decreased Personal Accomplishment Oh My: What Message Are We Sending To Our Students?, Nikki Sleddens, Betsy J. Becker

Posters and Presentations: Physical Therapy

PURPOSE:

The purpose of this presentation is to address the issue of burnout amongst PTs through the lens that addressing this issue in our profession may very well be the first step in building resilience in the academic and clinical environments.

METHODS AND/OR DESCRIPTION:

Physical therapy student well-being is a priority for academic institutions. Yet, are we, as academic and clinical faculty, who are responsible for promoting student well-being, “well” ourselves? Could burnout of our academic and clinical faculty impact our student’s wellness? Burnout is a syndrome described as emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. All effects …

Swallow Strength Training Exercise For Elderly: A Health Maintenance Need, D. Agrawal, Mark Kern, F. Edeani, Gokulakrishnan Balasubramanian, Allison S. Hyngstrom, Patrick Sanvanson, Rita Shaker

Physical Therapy Faculty Research and Publications

Background: Recent studies have shown high prevalence of oropharyngeal dysphagia associated with frailty‐ and age‐related muscle weakness. Strength training exercises have been advocated for locomotive health maintenance in the elderly and have shown positive outcomes. As muscles involved in oropharyngeal phase of swallowing are also comprised of striated muscles, the aim of this study was to determine biomechanical effect of a novel resistance exercise program, Swallowing Against Laryngeal Restriction (SALR), on pharyngeal phase swallowing in the healthy elderly. Methods: A total of 28 volunteers (75 + 7 years; 17 females) with no complaint of dysphagia were studied using video fluoroscopy …

Home-Based, Square-Stepping Exercise Program Among Older Adults With Multiple Sclerosis: Results Of A Feasibility Randomized Controlled Study, Emerson Sebastião, Edward Mcauley, Ryosuke Shigematsu, Brynn C. Adamson, Rachel E. Bollaert, Robert W. Motl

Exercise Science Faculty Research and Publications

There is very little known about exercise rehabilitation approaches for older adults with multiple sclerosis (MS), yet this growing segment of the MS population experiences declines in cognition and mobility associated with disease progression and aging. We conducted a RCT examining the feasibility of a 12-week, home-based Square-Stepping Exercise (SSE) program in older adults with MS. Older adults with MS (N = 26) with mild-to-moderate levels of disability were recruited and randomized into the intervention (i.e., SSE) or a minimal activity, attention-control conditions. Participants in the SSE condition received a mat for home-based practice of the step patterns, an …

Promis Pain Interference Is Superior Vs Numeric Pain Rating Scale For Pain Assessment In Foot And Ankle Patients, David N. Bernstein, Meghan Kelly, Jeff Houck, John P. Ketz, Samuel Flemister, Benedict F. Digiovanni, Judith F. Baumhauer, Irvin Oh

Faculty Publications - College of Physical Therapy

Background: The Numeric Pain Rating Scale (NPRS) is a popular method to assess pain. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been suggested to be more accurate in measuring pain. This study aimed to compare NPRS and PROMIS Pain Interference (PI) scores in a population of foot and ankle patients to determine which method demonstrated a stronger correlation with preoperative and postoperative function, as measured by PROMIS Physical Function (PF).

Methods: Prospective PROMIS PF and PI and NPRS data were obtained for 8 common elective foot and ankle surgical procedures. Data were collected preoperatively and postoperatively at a …

Idiopathic Proximal Tibiofibular Joint Laxity In A Collegiate Baseball Player: A Case Report, Stephen A. Cage, Brandon J. Warner, Diana M. Gallegos, Phil Stevenson

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Objective: Present a clinical case detailing the assessment and management of a collegiate baseball player suffering from symptomatic laxity of the proximal tibiofibular joint. Background: Injuries to the proximal tibiofibular joint are rare, and generally accompanied by some form of trauma. Typically, dislocations of the proximal tibiofibular joint occur in an anterior direction, and require reduction and possible fixation as a first course of treatment. Treatment: A 20-year-old collegiate baseball player reported to the athletic training clinic complaining of idiopathic lateral right knee pain. The patient could not recall a mechanism, but recalled an insidious onset of pain that …

Effects Of Compex As A Warm Up For Glenohumeral Range Of Motion, Melissa Ericson, Elizabeth R. Neil, Kenneth E. Games

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Research regarding proper upper extremity warm-up protocols remains inconclusive, especially for electrical stimulation methods like the Compex Sport Elite^® unit. The purpose of this study is to evaluate the acute effects of a single treatment of the Compex^® using the pre-warm-up protocol on glenohumeral range of motion compared to a standardized upper body ergometer (UBE) warm-up protocol. Methods: Thirty-five healthy, young adults completed the study (19 men, 16 women; age=22±2y; height=172.1±9.4cm; mass=71.3±16.1kg; right-hand dominant=28; left-hand dominant=7). Participants came to the research laboratory on two occasions, at least 48 hours apart. Participants were randomly assigned the order to …

Effect Of Ankle Taping On Dynamic Balance And Perception Of Stability, William S. Gear, Megan J. Lundstrom

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: The purpose of this study was to examine the actual and perceived effect of taping on dynamic stability. Methods: 21 physically active subjects [12 females (age = 20.33 ± 1.44 years, height = 165 ± 0.05 cm, mass = 68.76 ± 12.69 kg), and 9 males (age = 21.33 ± 1.66 years, height = 180 ± 0.10 cm, mass = 86.54 ± 9.46 kg)] participated in this study. Dynamic stability and perception of stability were assessed barefoot and with the ankle taped. The taped ankle condition used a standard preventive tape application including two anchors, three stirrups, close …

Hand Issues On Scleroderma Patients, Ana Font Hernandez

Publications and Research

Based on the design of a 3D-printed spoon prototype, we surveyed scleroderma patients about the device's value. 75% of patients mentioned having problems on their hands due to scleroderma. 85% of patients said their hand form changed because of the disease. Answers to the frequency or speed of the changes provide inconclusive results. The 3D printing technology has the potential to solve specific issues scleroderma patients face in their daily lives. Nevertheless, further research is needed to fully understand how hands shape change over time.

Enriched Physical Environment Attenuates Spatial And Social Memory Impairments Of Aged Socially Isolated Mice, Linmei Wang, Min Cao, Tinglin Pu, Huang Huang, Charles Marshall, Ming Xiao

Physical Therapy Faculty Publications

Background: Social isolation in the elderly is one of the principal health risks in an aging society. Physical environmental enrichment is shown to improve sensory, cognitive, and motor functions, but it is unknown whether environmental enrichment can protect against brain impairments caused by social isolation.

Methods: Eighteen-month-old mice were housed, either grouped or isolated, in a standard or enriched environment for 2 months, respectively. Behavioral tests were performed to evaluate cognitive functional and social interaction ability. Synaptic protein levels, myelination, neuroinflammation, brain derived neurotrophic factor, and NOD-like receptor protein 3 inflammasome signaling pathways were examined in the medial prefrontal cortex …

State Employment First Policies #2: Engaging Stakeholders In Development And Implementation, Jennifer Bose, Jean Winsor, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

This brief is the second in a series focusing on Employment First implementation as it relates to one of the seven elements within the High-Performing States in Integrated Employment model. It looks at the interagency collaboration and partnership element in depth. Interagency partnership and collaboration includes interagency agreements and relationships, provider collaboration, and outreach to stakeholders to ensure that integrated employment is a shared goal.
Case study data was collected for a sub-sample of seven states: Connecticut (CT), Delaware (DE), Kansas (KS), Minnesota (MN), Missouri (MO), Tennessee (TN), and Washington (WA). These states were selected because they represent a wide …

Locomotor Adaptations To Prolonged Step-By-Step Frontal Plane Trunk Perturbations In Young Adults, Eric R. Walker, Allison S. Hyngstrom, Tanya Onushko, Brian D. Schmit

Physical Therapy Faculty Research and Publications

The purpose of this study was to quantify the magnitude and time course of dynamic balance control adaptations to prolonged step-by-step frontal plane forces applied to the trunk during walking. Healthy young participants (n = 10, 5 female) walked on an instrumented split-belt treadmill while an external cable-driven device applied frontal plane forces to the trunk. Two types of forces were applied: 1) forces which accentuated COM movement in the frontal plane (destabilizing) and 2) forces which resisted COM movement in the frontal plane (stabilizing). We quantified dynamic balance control using frontal plane measures of (1) the extent of center …

Lean Mass Mediates The Relation Between Temporal Summation Of Pain And Sex In Young Healthy Adults, Abdulaziz Awali, Ali Alsouhibani, Marie K. Hoeger Bement

Physical Therapy Faculty Research and Publications

Background

Previous studies have shown that women experience greater temporal summation (TS) of pain than men using a repetitive thermal stimulus. These studies, however, did not individualize the thermal stimulus to each subject’s thermal pain sensitivity. The aim of this study was to investigate sex differences in TS using an individualized protocol and potential mediators that have been shown to influence TS including physical activity and body composition.

Methods

Fifty young healthy men and women (21 men) participated in the study. Subjects completed TS testing on the right forearm using a repetitive thermal stimulus at a temperature that the subject …

Effectiveness Of A Modified Lifestyle-Integrated Functional Exercise Program In Residential Retirement Communities—A Pilot Study, Kitsum Li, Kayla Comer, Tiffany Huang, Kelly Schmidt, Matthew Tong

Occupational Therapy | Faculty Scholarship

Aims: This study explored the effectiveness of a modified Lifestyle-integrated Functional Exercise program for increasing community-dwelling older adults’ lower body strength and balance to decrease fall risk.

Methods: Purposive sampling of men and women aged 65 years and older, with or without a history of falls, living at retirement communities yielded 19 older adult participants, and 16 of the participants completed the 26-week integrated exercise program. The program consisted of five-group training sessions focused on how to integrate individualized exercises into everyday activities, followed by 20 weeks of independent practice with a booster session at Week 10 and two phone …

Relationships Between Variance In Electroencephalography Relative Power And Developmental Status In Infants With Typical Development And At Risk For Developmental Disability: An Observational Study, Andrew Hooyman, David Kayekjian, Ran Xiao, Crystal Jiang, Douglas L. Vanderbilt, Beth A. Smith

Physical Therapy Faculty Articles and Research

Background: Electroencephalography (EEG) is a non-invasive tool that has the potential to identify and quantify atypical brain development. We introduce a new measure here, variance of relative power of resting-state EEG. We sought to assess whether variance of relative power of resting-state EEG could predict i) classification of infants as typical development (TD) or at risk (AR) for developmental disability, and ii) Bayley developmental scores at the same visit or future visits.

Methods: A total of 22 infants with TD participated, aged between 38 and 203 days. In addition, 11 infants broadly at risk participated (6 high-risk pre-term, …

Bringing Employment First To Scale: State Of The Science As A Knowledge Translation Strategy, John Kramer, Caro Narby, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

To synthesize our findings to date, the ThinkWork team at ICI developed 3 draft papers that captured the core themes from our RRTC on Advancing Employment for Individuals with Intellectual and/or Developmental Disabilities (IDD). We asked experts in the field to weigh in on these papers, and then broadly disseminated the papers to multiple audiences. Our primary goal was to engage with a diverse group with a range of perspectives and experiences, including fellow researchers, state agency employees, rehabilitation providers, and individuals with IDD and their families. To reach this goal we used a Knowledge Translation (KT) process. KT has …

Bringing Employment First To Scale: Writing For Families: Tips To Increase The Impact Of Training Materials, Jennifer Bose, John Kramer, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

This brief covers some of the lessons learned in reviewing literature designed to engage with families about employment. It suggests some tips and strategies to use with families to increase effective involvement and collaboration.

A Framework For Secondary Cognitive And Motor Tasks In Dual-Task Gait Testing In People With Mild Cognitive Impairment., Susan W Hunter, Alison Divine, Courtney Frengopoulos, Manuel Montero Odasso

Physical Therapy Publications

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).

METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined …

Incidence, Patterns And Associated Factors For Occupational Injuries Among Agricultural Workers In A Developing Country, Unaib Rabbani, Zafar Fatmi

Community Health Sciences

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country.
Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic …

Building An Evidence-Based, Holistic Approach To Advancing Integrated Employment, Allison C. Hall, John Butterworth, Jean Winsor, John Kramer, Kelly Nye-Lengerman, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Since the introduction of supported employment in the Developmental Disabilities Act of 1984 and the Rehabilitation Act Amendments of 1986, there has been continued development and refinement of best practices in employment services and supports. Progress includes creative outcomes for individuals with significant support needs including customized jobs and self-employment, community rehabilitation providers that have shifted emphasis to integrated employment, and states that have made a substantial investment in Employment First policy and strategy. Despite these achievements, the promise of integrated employment remains elusive for the majority of individuals with intellectual and developmental disabilities. The number of individuals supported in …

Strengthening Employment Services For Job Seekers With Intellectual And Developmental Disabilities (Bringing Employment First To Scale, No 15), Alberto Migliore, Kelly Nye-Lengerman, Oliver Lyons, John Butterworth, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Strengthening the effectiveness of employment services for job seekers with disabilities is key for improving their employment outcomes and their financial self-sufficiency. The purpose of this brief is to examine the quality of employment services available to job seekers with disabilities, and to offer recommendations for improvement. Findings are from a longitudinal study that involved 61 employment 37 employment programs in 17 states. Data were collected through a survey employment specialists, delivered to the job developers, or participants’ business developers. smartphones every work day for one year. Based on these findings and the literature about effective employment support practices, we …