Medicine and Health Sciences Commons^™

Experiences Of Adolescents In The General Education Setting Interacting With Peers With Intellectual Disability, Katie Goldey

Theses and Dissertations--Rehabilitation Sciences

Social interaction is critical to health, quality of life, and linguistic and cognitive development. However, young people with intellectual disabilities are unlikely to have equitable opportunities for social interaction. This may be particularly true of adolescents. This study used qualitative phenomenological methods to examine the lived experiences of students in the general education setting interacting with their peers with intellectual disability. Twenty participants engaged in one on one interviews with the author. Interviews were recorded, transcribed verbatim, and analyzed for overarching themes. Four main themes emerged from the data including: (1) Teens just don’t have many opportunities to interact with …

Injury-Related Fear In Patients After Anterior Cruciate Ligament Reconstruction, Shelby Elyse Baez

Theses and Dissertations--Rehabilitation Sciences

Approximately 200,000 anterior cruciate ligament (ACL) injuries occur each year with about 100,000 of these injuries undergoing reconstruction (ACLR). The impetus of ACLR is to allow previously high functioning, physically active individuals to return to desired levels of sports participation and to engage in recommended levels of physical activity. However, 1 out of 3 patients after ACLR fail to return to competitive levels of sport and meet recommended levels of physical activity. Injury-related fear has been cited as the primary barrier for failure to return to sport. However, the research has been primarily qualitative in nature and limited research has …

Growing Old As A Rock Star: A Four-Part Study Of The Aging Voice, Joanna Sloggy

Theses and Dissertations--Rehabilitation Sciences

This dissertation focuses on the aging voice - specifically the aging elite vocal athlete. It is comprised of four components; a series of research studies and a viewpoint piece designed to explore the awareness, struggles, and vocal compensations of aging singers dealing with age related vocal and performance problems. The overarching goal of these studies is to inform the development of a voice care protocol for the aging rock star to guide customized intervention for these elite vocal athletes that is focused on optimizing both vocal output and performance.

First, the dissertation introduces and identifies characteristics of the exceptional voice. …

Connecting The Pieces: How Low Back Pain Alters Lower Extremity Biomechanics And Shock Attenuation In Active Individuals, Alexa Johnson

Theses and Dissertations--Rehabilitation Sciences

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with …

A Comprehensive Assessment Of Crisis In Individuals With Intellectual Disabilities And Its Implications For Physical Therapy, Kathleen Sutton

Theses and Dissertations--Rehabilitation Sciences

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can …

Prevalence Of Sports-Related Stress Urinary Incontinence In The Female Collegiate Athlete, Stacey Pagorek

Theses and Dissertations--Rehabilitation Sciences

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.

Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in …

Evidence-Based Music Therapy Treatment To Elevate Mood During Acute Stroke Care, Jessica L. Rushing

Theses and Dissertations--Rehabilitation Sciences

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The …

Changes In Muscle Size, Quality And Power Are Related To Physical Function In Patients With Critical Illness, Kirby Mayer

Theses and Dissertations--Rehabilitation Sciences

Patients admitted to intensive care unit (ICU) are known to develop significant impairments in physical function. Patients with critical illness suffer up to 30% reductions in muscle size within the first ten days of admission to the ICU. Muscle strength testing, Medical Research Council-sum score, is current gold-standard to diagnosis ICU-acquired weakness and predicts risk of mortality and long-term physical function. Muscle power different from muscle strength in that it accounts for velocity of movement, is potentially a better independent predictor of function that has not been studied in this population. In addition, we hypothesize that muscle size and quality …

Mobility Boost: A Quality Improvement Project To Bridge A Gap In Care For Hospitalized Adults, Audrey M. Johnson

Theses and Dissertations--Rehabilitation Sciences

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early …

Readiness For Discharge After Total Knee Replacement: Exploring Patients’ Perceptions Of Discharge Preparation And Providers’ Descriptions Of Pre-Operative Education, Renee Causey-Upton

Theses and Dissertations--Rehabilitation Sciences

Discharge readiness following total knee replacement (TKR) has often been defined using quantitative factors, such as knee range of motion or walking a specified distance. These measurements fail to include other features that could impact readiness for discharge, such as social support or patient perceptions. Most patients have positive results following TKR surgery, however others experience negative outcomes such as falls, reduced functional performance, and hospital readmission. Readiness for returning home after TKR begins with pre-operative education to prepare patients for surgery and the post-operative phase. Health care providers must have a clear understanding of patients’ perceptions of readiness to …

The Role Of Psychosocial Factors On Pre And Postoperative Pain In Patients With Femoral Acetabular Impingement, Kate N. Jochimsen

Theses and Dissertations--Rehabilitation Sciences

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes.

Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). …

Parent-Implemented Language Intervention With Young Children From Low-Ses Environments Who Have Language Impairment, Courtney Allison Hatcher

Theses and Dissertations--Rehabilitation Sciences

In this study, the author examined the effects of training four parents from low-socioeconomic environments to use Enhanced Milieu Teaching (EMT) with their young children with language impairment. The investigator used a modified Teach-Model-Coach-Review method to teach parents to use the following EMT strategies during 8-10 individualized, home-based sessions: matched turns, expansions, time delays and milieu teaching prompts. A single-case multiple-baseline design across-behaviors replicated across four parent/child dyads was used to evaluate the parents' use of the EMT strategies. Child language outcomes were also assessed using pre- and post-intervention language samples. All parents learned and demonstrated use of each language …

Tissues And Trauma: Pain Neuroscience Education For Veterans With Post-Traumatic Stress And Low Back Pain, Timothy Mark Benedict

Theses and Dissertations--Rehabilitation Sciences

Low back pain (LBP) is the top reason for Soldiers to seek medical care and one of the top reasons to be medically discharged. Mental health problems and psychosocial stressors have been increasing in Soldiers and are also top causes for medical discharge. Dysregulated stress has contributed to many Soldiers and Veterans to develop chronic LBP as well as mental health disorders like post-traumatic stress disorder (PTSD). Research suggests that psychosocial characteristics, as opposed to physical factors or tissue health, contribute to chronic pain the most. Focusing entirely on tissues for individuals seeking care for LBP can increase disability and …

Thrombolysis And Early Speech And Language Recovery After Stroke, Sarah E. Campbell

Theses and Dissertations--Rehabilitation Sciences

Speech and language impairments after left hemisphere stroke are life altering. Neuroprotective interventions, such as tissue plasminogen activator, or tPA, are utilized to diminish the impact of the stroke on functional ability.

The purpose of this study was to examine speech and language recovery in the first three months after stroke in individuals with aphasia and to further investigate any differences between individuals who did and individuals who did not receive tPA, using objective speech and language measures.

Twenty-six individuals, thirteen of whom received tPA and thirteen who did not, suffering from first-ever left hemisphere stroke with resulting aphasia were …

The Assessment And Utilization Of Patients’ Self-Efficacy For Exercise During Rehabilitation, Kelsey J. Picha

Theses and Dissertations--Rehabilitation Sciences

Patient adherence to in-clinic rehabilitation is between 30-70% and even lower for home exercise programs (HEPs). Barriers to patient adherence have been identified and include but are not limited to anxiety, depression, lack of positive feedback, lack of social support, lack of time, low levels of physical activity at baseline, pain during exercise, and low self-efficacy. As clinicians prescribing rehabilitation may not be able to influence all of the identified barriers, they may positively influence others. Self-efficacy, or an individual’s belief in his/her ability to successfully complete a task, is a patient barrier that may be addressed by a clinician …

Joint Decision-Making In Married Couples Affected By Aphasia, Ryan S. Husak

Theses and Dissertations--Rehabilitation Sciences

Background: Aphasia is an acquired language disorder, usually due to stroke, that affects the social functioning and the quality of life of the person with aphasia as well as the quality of life of his or her family and caregivers. Traditional aphasia therapy has tended to focus on decontextualized tasks and discrete elements of language functioning. The Life Participation Approach to Aphasia (LPAA) focuses on the collaborative nature of communication and addresses communication within personally relevant contexts. Joint decision-making is one type of social interaction that occurs frequently between married couples and has received considerable attention in the literature. …

Social Participation In Schools: Developing The Role Of Occupational Therapy Practitioners, Kelly L. Leigers

Theses and Dissertations--Rehabilitation Sciences

The aim of this dissertation is to build the repertoire of occupational therapy practitioners so that they are better prepared in the provision of services addressing social participation of students with disabilities in the general education classroom. Students with disabilities in general education classrooms tend to have greater difficulty establishing and maintaining friendships (Wight & Chapparo, 2008), have fewer reciprocated friendships (Kemp & Carter, 2002), and lower stability in relationships than peers without disabilities. Furthermore, studies indicate that students with disabilities are less social accepted (Ekornas, Heimann, Tjus, Heyerdahl, & Lundervold, 2011) and are more isolated (Nadeau & Tessier, 2006). …

Prediction Of Acute And Recurrent Ankle Sprains In Athletes, Ryan S. Mccann

Theses and Dissertations--Rehabilitation Sciences

Ankle sprains are not only among the most common sport-related injuries, but also associated with a high rate of recurrence. While prevention is a favorable approach to reducing the incidence of index and recurrent ankle sprains, identifying individuals at greater risk may improve allocation of preventative resources. This dissertation aimed to accomplish the following through three aims: 1) determine the ability of baseline clinical tests to predict acute lateral ankle sprain (LAS) in an understudied athletic population, 2) describe the degree of residual impairments and activity limitations in athletes returning to play from a LAS, and 3) determine the ability …

Chronic Ankle Instability And Aging, Kyle B. Kosik

Theses and Dissertations--Rehabilitation Sciences

Lateral ankle sprains are the most common musculoskeletal injury among the general population and U.S. military personnel. Despite the common perception of being a minor injury, at least 1 out of 3 individuals with a previous ankle sprain will develop chronic ankle instability (CAI). This clinical phenomenon creates a significant barrier for patients to return to their prior level of physical function. Specifically, CAI is associated with reductions in physical activity level, leading to decreases in lower health-related quality of life and increase risk of developing of post-traumatic ankle osteoarthritis. Current evidence has largely focused on characterizing the mechanical and …

Longitudinal Adaptations In Muscle Strength, Functional Performance, Gait Biomechanics, And Patient-Reported Function After Unilateral Total Knee Arthroplasty, Paul W. Kline

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to impairments after total knee arthroplasty (TKA) (Aim 1) and define recovery between 3 and 6 months after TKA across four domains: 1) hip and knee muscle performance, 2) functional performance, 3) patient-reported function, and 4) biomechanics of walking and stair descent (Aim 2). Additionally, this project sought to explore the relationships between each domain (Aim 3) and establish predictive models to allow clinicians to use clinical measures to predict future gait biomechanics in patients after TKA (Aim 4). Ultimately, the results of this research would …

A Grounded Theory Study Of Maternal Engagement Of Low Income, Young Rural Mothers In Home-Based, Early Intervention Services, Elaine K. Fehringer

Theses and Dissertations--Rehabilitation Sciences

Home-based, early intervention programs as a preferred delivery model are widely endorsed, heavily funded and highly utilized as prevention and remediation initiatives for families with young children (Eckenrode, et al., 2010; Karoly, Killion, & Cannon, 2005). Of concern, is that while an estimated 40 billion dollars are spent annually between federally funded programs and private foundations, a significant number of families disengage from services before the end of a child’s eligibility period (Stevens, Ammerman, Putnam, Gannon, & van Ginkel, 2005). Several meta-analyses indicate only modest effectiveness of home-based services (Tandon, et al., 2008). It is estimated that well over 500,000 …

The Effect Of One-On-One Intervention In Athletes With Multiple Risk Factors For Injury, Kathryn Schwartzkopf-Phifer

Theses and Dissertations--Rehabilitation Sciences

Background: Lower extremity (LE) musculoskeletal injuries in soccer players are extremely common. These injuries can result in many days of lost time in competition, severely impacting players and their respective teams. Implementation of group injury prevention programs has gained popularity due to time and cost-effectiveness. Though participation in group injury prevention programs has been successful at reducing injuries, programs often target a single injury and all players do not benefit from participation. Players with a greater number of risk factors are most likely to sustain an injury, and unfortunately, less likely to benefit from a group injury prevention program. …

Effect Of A 12-Week Home-Based Neuromuscular Electrical Stimulation Treatment On Clinical Outcomes Following Articular Cartilage Knee Surgery, Caitlin E. Whale Conley

Theses and Dissertations--Rehabilitation Sciences

Articular cartilage defects in the knee are common, and can result in pain, decreased function and decreased quality of life. Untreated defects are considered to be a risk factor for developing osteoarthritis, a progressive degenerative joint disease with minimal treatment options. To address these issues, various surgical procedures are available to treat articular cartilage defects in the knee. While these procedures overall have positive results, after surgery patients experience large and persistent deficits in quadriceps strength. A contributing factor to this post-surgical weakness is believed to be the extended post-operative non-weight bearing period, with full weight bearing not initiated until …

The Relationship Between Selective Attention And Global Coherence In Narrative Discourse Following Right Hemisphere Stroke, Katherine Mccomas Maddy

Theses and Dissertations--Rehabilitation Sciences

Stroke is the leading cause of serious, long-term disability and nearly half of older stroke survivors experience moderate to severe disability. A common impairment following stroke is impaired discourse production. Functional outcome studies have proposed that the recovery of discourse abilities is critical to achieving a good quality of life. Communication impairments often persist into the chronic stages of recovery and can cause individuals to withdraw from social situations. Discourse production deficits may not be apparent in basic communication interactions, but become more obvious during complex conversations following non-aphasic brain injury (NABI) or right hemisphere stroke (RHD). The purpose of …

A Biomechanically Based Observational Tennis Serve Analysis Method Can Be Used To Assess Serve Mechanics, Natalie Myers

Theses and Dissertations--Rehabilitation Sciences

Traditional sports science motion analysis techniques using three-dimensional (3D) kinematics have demonstrated that proper mechanics enhance serve performance and improper mechanics overload tissues resulting in injury. However 3D analysis is costly, time-consuming, and requires extensive knowledge of biomechanical properties and data analysis. Currently there are no simple, reliable, and valid observational methods for health care providers (HCP) and tennis professionals to evaluate tennis serve mechanics. Researchers investigating observational analyses have determined that superior reliability may be a result of specific operational definitions and the incorporation of educational training sessions on how to perform the analysis.

The first purpose of this …

Retrospective Frames Of Disability: Themes Derived From Parents Of Children Who Grew Up With Congenital Disability, Sheryl L. Holt

Theses and Dissertations--Rehabilitation Sciences

Introduction: For children born with physical disabilities, the perspectives and actions of their parents prove significant to their childhood developmental outcomes clinically, educationally, socially, and with regard to community participation. The lived world and perceptions of parents who have children with disabilities however is not well investigated. This study sought to understand parents’ framing of theirs and their children’s disability experiences. Family systems together with family systems intervention models, and disability theory were used to provide structure to interview instrumentation and subsequent analysis. Child-centered and ecologic influences were also used to track the transformative processes over time that infuses parental …

Temporal Neuromuscular Alterations Of The Quadriceps After Unilateral Anterior Cruciate Ligament Reconstruction, Conrad M. Gabler

Theses and Dissertations--Rehabilitation Sciences

Objective: The primary aim of this research was to examine the temporal pattern of neuromuscular quadriceps deficits in both the involved and uninvolved limbs of patients assigned to the control group after anterior cruciate ligament reconstruction (ACLr), by assessing quadriceps strength, voluntary activation, and corticomotor excitability prior to surgery (baseline), three months after ACLr, and six months after ACLr. A secondary aim of this research was to determine whether quadriceps strength, voluntary activation, and/or corticomotor excitability assessed in patients prior to ACLr and/or at three months after surgery, is predictive of lower extremity postural control and/or self-reported function at six …

Investigating The Efficacy Of Vocal Function Exercises In Improving Vocal Function In Adults Irradiated For Laryngeal Cancers: A Three Part Dissertation, Vrushali Angadi

Theses and Dissertations--Rehabilitation Sciences

Deterioration in voice quality following radiation therapy for the treatment of laryngeal cancers (LC) is well documented in literature. The majority of studies show that these voice problems are long term and in some cases permanent. Deterioration in voice quality, especially over a period of time could lead to significant communication difficulties in daily life or in some cases could even result in loss of profession. Despite the negative effects of radiation therapy on voice quality being well documented, few studies have focused on the efficacy of voice therapy in the irradiated LC population.

The purpose of this study was …

Prospective Assessment Of Return To Pre-Injured Levels Of Activity, Aaron D. Sciascia

Theses and Dissertations--Rehabilitation Sciences

Determining return to pre-injured levels of play following athletic injury can be challenging. The current practice of making decisions following rehabilitation as to whether or not a patient has returned to pre-injured levels of activity is potentially inaccurate because initial assessments of perceived physical capability are performed at a time of relative dysfunction or are based on patient recall. Since there is no true baseline of perceived and physical function prior to injury it is difficult to determine if an athlete has return to baseline or is simply better than they were at the time of injury. Therefore, it is …

Vocalization Subsystem Responses To A Temporarily Induced Unilateral Vocal Fold Paralysis, Daniel J. Croake

Theses and Dissertations--Rehabilitation Sciences

Healthy voicing is thought to be dependent on a dynamic balance of three interactive subsystems: respiration, phonation, and resonance. Theoretically, multiple patterns of subsystem interactions likely underlie healthy voice production; however surprisingly little quantitative data exists defining the nature of these subsystem production patterns and interactions across individuals.

The central aim of this study was to quantify the interactions of the vocalization subsystems in a non-perturbed and perturbed condition (induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Respiratory inductance plethysmography, laryngeal aerodynamics, and acoustic formant data were used to measure the proportional contributions of, and changes to, the …