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Childhood Cancer Survivorship: Navigating A New Normal In Middle Tennessee, Karli M. Beaumont Apr 2024

Childhood Cancer Survivorship: Navigating A New Normal In Middle Tennessee, Karli M. Beaumont

OTD Capstone Projects

Monroe Carell Jr. Children’s Hospital at Vanderbilt in partnership with Vanderbilt-Ingram Cancer Center offers REACH for Cancer Survivorship, a pediatric cancer survivorship clinic. REACH provides a full range of follow-up care designed to meet the physical, emotional, and practical needs of survivors and continuous surveillance of deleterious effects of cancer and its treatments. The purpose of this project was to meet population and agency needs through research of long- and late-term sequela while advocating for occupational therapy’s role in the oncology population through the proactive therapy and prospective surveillance models. The process of creating this project included synthesizing the literature, …


Prevalence Of Depression In Physical Therapy Environments For Young Adult Populations In The U.S.: A Systematic Literature Review, Audrey N. Baucom Apr 2024

Prevalence Of Depression In Physical Therapy Environments For Young Adult Populations In The U.S.: A Systematic Literature Review, Audrey N. Baucom

Honors College Theses

Objective: This systematic review aimed to examine interactions of depression symptoms and diagnoses and its prevalence in physical therapy settings among the young adult population ages 18-24 in the United States through current literature and to identify existing literature. Methods: This review followed the PRISMA guidelines to form a systematic review. Ten databases were extensively searched. Results were screened by one researcher and those that met the criteria were verified as inclusive by a second researcher. Results: The search yielded 3,017 results and included two studies. In each study, age was not identified as a prevalent variable in mental health …


Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan Feb 2024

Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan

Electronic Thesis and Dissertation Repository

Patient-centered care (PCC) is a growing standard for healthcare delivery due to the benefits to patient autonomy. Lacking a cohesive definition in the physiotherapy literature, it is also lacking in implementation. Employing interpretive description with semi-structured interviews, the goal was to understand how physiotherapists drawn from private for-profit clinics in Canada describe PCC, and barriers and facilitators to providing it. Results included requiring person-centered communication in PCC, seeing Health holistically, centering the patient in care, and being a skill that becomes clearer with practice experience. Barriers included: lack of practitioner reflexivity, patient not desiring self-directed care, and limited access to …


Workload Management Strategies To Promote Senior Physical Therapy Faculty Retention In The United States, Amanda Parrish Feb 2024

Workload Management Strategies To Promote Senior Physical Therapy Faculty Retention In The United States, Amanda Parrish

Walden Dissertations and Doctoral Studies

No abstract provided.


Development And Validation Of The Pain Resilience And Optimism Scale (Pros), Wonjin Seo Jan 2024

Development And Validation Of The Pain Resilience And Optimism Scale (Pros), Wonjin Seo

Electronic Thesis and Dissertation Repository

Numerous self-report questionnaires have been used in pain research to explore patients' experiences. However, these questionnaires often employ negatively worded items that can potentially worsen patients' distress. In response to the emergence of positive psychology, this thesis aimed to develop a new questionnaire that adopts a positive and strengths-focused approach, incorporating resilience, to replace the negative items found in existing tools such as the Pain Catastrophizing Scale (PCS). First, the effectiveness of the Connor-Davidson Resilience Scale (CD-RISC) in measuring resilience following trauma was assessed through a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments …


Sex Differences In The Effects Of Cortisol On Muscle Characteristics: A Meta-Analysis, Natalie Bitetti Jan 2024

Sex Differences In The Effects Of Cortisol On Muscle Characteristics: A Meta-Analysis, Natalie Bitetti

CMC Senior Theses

Background: Cortisol plays a central role in both muscle breakdown and growth. These effects are highly dependent on dose and interactions with other hormones. It is known that men and women show considerable differences in their muscle structure and physiology, which are largely driven by hormonal differences. Cortisol release patterns may also vary between the sexes, with current research showing considerable disagreement. The interplay between cortisol and muscle, two highly variable and sexually dimorphic factors, may prove to have different effects in males versus females.

Objective: This meta-analysis integrates existing research on sex differences in cortisol-muscle physiology with existing research …


The Impact Of Sitting And Crawling On The Acquisition Of Object Permanence In Infants With Motor Delays And Infants With Typical Development, Karl Jancart Dec 2023

The Impact Of Sitting And Crawling On The Acquisition Of Object Permanence In Infants With Motor Delays And Infants With Typical Development, Karl Jancart

Electronic Theses and Dissertations

Object permanence (OP) is the ability to understand that objects continue to exist even when they cannot be perceived. During play, infants with an understanding of OP will continue searching for toys when the toys have been obscured by other items. Searching requires movement. The theory of embodied cognition maintains that the form and function of an organism’s body influence how the organism learns; Therefore, if a child has difficulties with movement, as demonstrated by children with motor delays, they will likely have difficulty engaging in play, the modality by which children learn about their world. The current research is …


Hippotherapy Within Physical Therapy Treatment: Helping Patients With Cerebral Palsy Achieve Functional Goals, Grace Kucienski Dec 2023

Hippotherapy Within Physical Therapy Treatment: Helping Patients With Cerebral Palsy Achieve Functional Goals, Grace Kucienski

Honors Capstones

Hippotherapy is a treatment tool that can be utilized by trained occupational therapists, speech language pathologists, and physical therapists. It involves the utilization of a horse’s movement to facilitate certain sensory, adaptive, neuromotor, cognitive, and physical responses from a patient. The purpose of this project is to examine how hippotherapy as a treatment tool in physical therapy benefits children with cerebral palsy. The examination of this subject matter was conducted in a case study format. For twelve weeks, one patient with cerebral palsy’s physical therapy sessions utilizing hippotherapy were observed. During these sessions, her progress towards reaching a specific functional …


Anatomy Of The Ankle And Ankle Injuries In Athletes, Isabelle G. West Dec 2023

Anatomy Of The Ankle And Ankle Injuries In Athletes, Isabelle G. West

Honors Capstones

The purpose of this project was to learn about the anatomy of the ankle joint, explore common ankle injuries in athletes, and research how they are treated overall and in a physical therapy setting. To do so, a dissection of the ankle joint was completed with Mrs. Kara Coffman-Rea in the cadaver lab as well as an exploration of plastinated models. Additionally, a literature review of current research on the ankle was completed. Though many structures of the ankle joint were identified through dissection, the focus of the literature review is on the structures of the lateral ankle and the …


Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi Nov 2023

Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi

Electronic Thesis and Dissertation Repository

Arthritis is a common disorder that may result in pain and inflammation, making it challenging to move or continue being active. Arthritis comes in a variety of forms. The two studies of this thesis aimed to identify the influence of intersectionality, especially sex and gender, in arthritis. The first study, a structured review, evaluated the inclusion of sex/gender and intersectional identities in patient resources of three arthritis societies: the Canadian Arthritis Society, the American Arthritis Foundation, and the National Rheumatoid Arthritis Society. The appraisal tool, the Sex/Gender and Intersectional Considerations in Patient/Consumer Health Information Appraisal Tool was used to evaluate …


The Impact Of Boxing Exercise On The Quality Of Life In People Living With Parkinson's Disease, Jen Baker Nov 2023

The Impact Of Boxing Exercise On The Quality Of Life In People Living With Parkinson's Disease, Jen Baker

Master of Science in Nursing Final Projects

This integrative review aimed to explore the effects of boxing exercises on the quality of life (QOL) of people with Parkinson’s Disease (PwP). Boxing exercise programs are popular in the Parkinson’s Disease (PD) community. Decreasing motor symptoms tends to be a primary focus in exercise and PwP. However, non-motor symptoms are a side effect of PD that varies amongst individuals and can impact QOL. Understanding the effects of boxing, especially on non-motor QOL, can support practitioners when prescribing specific exercise modalities for PwP. An integrative review with the search of PUBMED, CINAHL, and MEDLINE was performed, and the methodology of …


Predicting Physical Therapy Student Clinical Reasoning In Practice Using Aligned Assessments In A Curricular Domain, Joy L. Moulton Oct 2023

Predicting Physical Therapy Student Clinical Reasoning In Practice Using Aligned Assessments In A Curricular Domain, Joy L. Moulton

Doctor of Education (Ed.D)

Clinical reasoning (CR) is a difficult concept to assess and is a leading cause of failure for outpatient clinical experiences for physical therapy (PT) students (Silberman et al., 2018). The purpose of this study was to determine to what degree didactic assessments of CR could predict CR in clinical practice utilizing Miller’s (1990) pyramid as a conceptual framework. Using a retrospective quantitative exploratory observational design, archived data were collected for graduates in the classes of 2022 and 2023 (N = 84) from a hybrid Doctor of Physical Therapy program. Each assessment pertained to the musculoskeletal domain of PT practice and …


A Reflection Of Experiences Of Adults With Type 1 Diabetes In Integrated Physical Education Classes, Kalleigh West Oct 2023

A Reflection Of Experiences Of Adults With Type 1 Diabetes In Integrated Physical Education Classes, Kalleigh West

Human Movement Sciences Theses & Dissertations

The purpose of this study was to gain an understanding of the experiences of type 1 diabetics in integrated physical education classes. In this study, we interviewed young type 1 diabetic adults and asked them to reflect on their school-based physical education experiences. An interpretative phenomenological analysis (IPA) approach was adopted to guide data collection, analysis, and interpretation for this retrospective study. Eight participants (ages 19 to 32) were enrolled in this study, and semi-structured interviews focused on their physical education experiences acted as the primary data. Transcribed interview data were analyzed using an IPA approach. Three interrelated themes emerged …


Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour Sep 2023

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …


Evaluation Of Conservative And Operative Treatments In Active Patients With Acromioclavicular (Ac) And Rotator Cuff (Rc) Injuries, Jesse Singh Aug 2023

Evaluation Of Conservative And Operative Treatments In Active Patients With Acromioclavicular (Ac) And Rotator Cuff (Rc) Injuries, Jesse Singh

Electronic Thesis and Dissertation Repository

Abstract

Introduction: Shoulder pain and disability, particularly acromioclavicular joint (ACJ) and rotator cuff (RC) injuries, are common in a physically active population. Determining operative or rehabilitative treatment plans involve multiple treatment choices influenced by the injury grade and treatment goals, such as return to sport. This thesis investigates the management of treatment for AC and RC injuries

Method: The first study is a scoping review that uses the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) to synthesize 32 studies involving athletes who have undergone conservative or operative treatment for their Rockwood grade III …


Developing Rehabilitation Treatment Decision Aid For People Living With Complex Regional Pain Syndrome (Crps), Erfan Shafiee Aug 2023

Developing Rehabilitation Treatment Decision Aid For People Living With Complex Regional Pain Syndrome (Crps), Erfan Shafiee

Electronic Thesis and Dissertation Repository

This Ph.D. dissertation aimed to develop a treatment decision aid for people with Complex Regional Pain Syndrome (CRPS) using the Ottawa Decision Support Framework (ODSF). The decision aid was developed throughout a two-phase process.

The first phase involved understanding the existing evidence and the factors influencing decision-making in CRPS rehabilitation: priorities and preferences of patients and therapists were considered. This phase encompassed the integration of diverse sources of evidence, including systematic reviews, overview of systematic reviews, critical appraisal of guidelines, and a survey exploring patients' and therapists' priorities and preferences for CRPS rehabilitation interventions. All forms of evidence were used …


A Community Dweller’S Perspective Of A Day Shoulder Arthroplasty Surgery., Bansari D. Patel Ms. Aug 2023

A Community Dweller’S Perspective Of A Day Shoulder Arthroplasty Surgery., Bansari D. Patel Ms.

Electronic Thesis and Dissertation Repository

The following study was a qualitative interpretive descriptive study aimed at investigating immediate barriers or difficulties in the lives of the community dwellers as well as modifications occurring in the daily routine activities shortly after the out-patient total shoulder arthroplasty procedure. The personal and surgical factors affecting at-home recovery were focussed alongside exploring the coping mechanisms and adaptations in everyday day life. The study mainly focused on the initial three weeks' duration after the discharge. The study followed the constructivist paradigm, adopting the interpretive description methodology. A total of 19 subjects who underwent same/ single day discharge total shoulder arthroplasty …


Exploring The Relationship Between Hemispheric Prefrontal Cortex Activation, Standing Balance, And Fatigue In Individuals Post-Stroke: A Fnirs Study, Sarthak Kohli Aug 2023

Exploring The Relationship Between Hemispheric Prefrontal Cortex Activation, Standing Balance, And Fatigue In Individuals Post-Stroke: A Fnirs Study, Sarthak Kohli

Electronic Thesis and Dissertation Repository

Balance impairments are common after stroke. Reasons for this are multifactorial and include motor dysfunction and fatigue. Limited research has explored the combined effects of post-stroke fatigue and balance on brain activation patterns. Research has shown that prefrontal cortex (PFC) activation may be involved in both motor control and fatigue throughout the recovery process post-stroke. The aim of this thesis was to determine whether: (1) PFC activation levels change between standing balance tasks, (2) PFC hemispheric activation is asymmetric during standing balance tasks, and (3) fatigue levels are associated with task-based activation. Patients with hemiparesis were recruited from the inpatient …


Exploring The Experiences Of Underrepresented Students Pursuing Health-Related Graduate Or Professional Programs, Alison Williams Aug 2023

Exploring The Experiences Of Underrepresented Students Pursuing Health-Related Graduate Or Professional Programs, Alison Williams

Electronic Theses and Dissertations

For many years graduate and professional education programs for the health professions have sought to increase the diversity of their student body to include students from a wider variety of backgrounds. Increasing the diversity of healthcare providers is an essential component of addressing inequities in healthcare. However, despite initiatives to increase racial and ethnic diversity in the health professions, these professions remain largely White and female. Previous researchers have sought to identify the reasons that racial and ethnic minorities are underrepresented in healthcare, and the barriers to persistence and success. Little research exists explaining why men are underrepresented in the …


Effects Of Static Versus Dynamic Cupping On Ankle Dorsiflexion, Alexandria N. Schaub Aug 2023

Effects Of Static Versus Dynamic Cupping On Ankle Dorsiflexion, Alexandria N. Schaub

All NMU Master's Theses

PURPOSE: Cupping therapy involves lifting and separating fascial tissue to facilitate stretching and promote blood flow. Although cupping is a common treatment modality for pain, studies are inconsistent in regards to whether cupping improves other outcomes, like range of motion. Possessing a limited range of motion can lead to musculoskeletal injury. The aim of this research is to determine the acute effect of different methods of cupping therapy on ankle dorsiflexion. METHODS: A total of 35 healthy adults (age: 22.1±4.52 years) with an average ankle ROM of 34.68±4.22° at baseline were included in the study. Participants were randomly …


Evaluating The Effectiveness Of Recent Educational Foundations Requirements By The Commission On Accreditation In Physical Therapy Education For Program Directors Of Physical Therapist Assistant Programs, Sharan Dawn Zirges Aug 2023

Evaluating The Effectiveness Of Recent Educational Foundations Requirements By The Commission On Accreditation In Physical Therapy Education For Program Directors Of Physical Therapist Assistant Programs, Sharan Dawn Zirges

Educational Foundations & Leadership Theses & Dissertations

On November 2015, the Commission on Accreditation of Physical Therapy Education (CAPTE) published position papers for the 2016 changes to the CAPTE standards. One of these position papers discussed the changes in the 2016 standards related to the qualifications for the position of a program director (PD) for a physical therapist assistant. A specific qualification requirement was added stating “experience in educational theory and methodology, instructional design, student evaluation and outcome assessment, including the equivalent of nine academic (semester) credits of coursework in educational foundations.” The effectiveness of this additional requirement has to date not been assessed. The purpose of …


Teaching Social Determinants Of Health In Physical Therapist Professional Education Programs: Exploring Curricular Approaches And Examining An Assessment Tool, Emily Jordan Hawkins Aug 2023

Teaching Social Determinants Of Health In Physical Therapist Professional Education Programs: Exploring Curricular Approaches And Examining An Assessment Tool, Emily Jordan Hawkins

Rehabilitation Sciences Theses & Dissertations

There is a growing emphasis and need for physical therapists (PTs) to serve not only as clinicians but also as advocates to pursue health equity. Clinical practice for preventing and rehabilitating injuries and promoting physical activity will not eliminate health disparities resulting from the social determinants of health (SDH). Leaders in the field of physical therapy have charged physical therapist professional education programs to teach future PTs to address SDH, however, as of August 2023, the Standards and Required Elements for Accreditation of Physical Therapist Education Programs does not specifically require curricular content regarding SDH. The purposes of this dissertation …


Strategies To Manage And Prevent Lower Back Pain In College Students, Onique Bryson May 2023

Strategies To Manage And Prevent Lower Back Pain In College Students, Onique Bryson

Honors Capstones

Many young adults who are in college often struggle with maintaining their physical well-being and thus encounter severe-moderate lower back pain (LBP). In this project, a research development plan was created that will test the effectiveness of utilizing physical therapy (PT) to treat and or prevent LBP. The scope includes using standard PT techniques to evaluate students who may be struggling with LBP and teach them different measures to help themselves. The limit of the project is that the hypothesis will only be tested on Northern Illinois University (NIU) students, so results may vary for larger populations. A survey will …


International Strategies For Addressing The Needs Of Children With Disabilities: Comparing Pediatric Therapy Services In Italy And The United States, Cassidy Hearn, Lillian Hsiao, Lavinia Fanelli, Regina Harbourne May 2023

International Strategies For Addressing The Needs Of Children With Disabilities: Comparing Pediatric Therapy Services In Italy And The United States, Cassidy Hearn, Lillian Hsiao, Lavinia Fanelli, Regina Harbourne

Physical Therapy Projects

This paper introduces and compares the professions of Neuro and Psychomotor Therapist of Developmental Age and pediatric physical therapy. Although pediatric physical therapy practice is prevalent in the United States, Italy utilizes another profession which encompasses many features of physical therapy, but also incorporates neuropsychological factors, specifically for children.


Effect Of Motivational Music On Peak Knee Torque, Perceived Exertion, And Enjoyment In College-Aged Individuals, Arianna Cole May 2023

Effect Of Motivational Music On Peak Knee Torque, Perceived Exertion, And Enjoyment In College-Aged Individuals, Arianna Cole

Undergraduate Honors Theses

There is a general consensus in previous and current literature that the incorporation of music in exercise has the potential to benefit performance (Karageorghis 2020; Terry et al. 2019). Research on the potential benefits of music in rehabilitative exercise has become more prevalent but has mainly focused on music and the rehabilitation of neurological conditions such as Parkinson's disease or stroke (Craig et al. 2015; De Bartolo et al. 2020; Grau-Sánchez et al. 2022; Katlen da Silva et al. 2021; Särkämö 2018). Research in a more general rehabilitative setting has not been explored as widely and this is the aim …


Creating A University-Based Performing Arts Clinic: Challenges And Lessons, Carissa Limtiaco, Alan Savanapridi May 2023

Creating A University-Based Performing Arts Clinic: Challenges And Lessons, Carissa Limtiaco, Alan Savanapridi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Fine artists performing at the collegiate level are at a high risk for developing performance related musculoskeletal injuries due to the unique physical demands and repetitive nature of their movements. Previous research has reported incidence rates as high as 81% and 62% for student dancers and musicians respectively. Despite the high injury rates, research has shown that student performers underreport injuries and are reluctant to seek medical management from health professionals due to unhealthy beliefs and attitudes often held by this population as well as the lack of specialized healthcare. The goal of the UNLV College of Fine Arts (CFA) …


Effects Of Postural Load Perturbations On The Stroke-Impaired Spinal Circuitry, Jose Galvez, Linh Thi My Nguyen, Brandon Yee May 2023

Effects Of Postural Load Perturbations On The Stroke-Impaired Spinal Circuitry, Jose Galvez, Linh Thi My Nguyen, Brandon Yee

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective Transitioning from supported sitting position to standing activities requires coordinated interactions among postural muscles with appropriate reflexive responses to adapt to an increase in postural loading. Previous studies have found the failure to accommodate the challenge of increased postural loads in the stroke-impaired nervous system. In this study, we examined the H-reflex in response to different magnitudes of loads under static postural conditions, and compared the responses directly between individuals with a stroke-impaired nervous system and those with a non-neurologically impaired nervous system. We tested the hypothesis that the reflex amplitude would increase with increased load during standing in …


Developing A Physical Therapy Initial Evaluation Screening Tool For A Multidisciplinary Clinic For Adults With Down Syndrome, Isabella Russell, Alvin Lacap, Francis Lacap May 2023

Developing A Physical Therapy Initial Evaluation Screening Tool For A Multidisciplinary Clinic For Adults With Down Syndrome, Isabella Russell, Alvin Lacap, Francis Lacap

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: Down syndrome (Ds) is a chromosomal condition that can result in intellectual disability, as well as structural or functional disorders impacting the nervous, cardiovascular, and musculoskeletal systems. As individuals with Ds age, they can have an increased number of comorbidities that impact their health. Physical therapy can play an important role in managing many of the comorbidities adults with Ds have. Therefore, there is an increased need for physical therapists to efficiently screen, evaluate and treat adults with Ds. The purpose of this work is to create an Initial Evaluation Screening Tool and Patient Intake Form for physical therapists …


Analyzing Equity Within The University Of Nevada, Las Vegas Physical Therapy Program Admissions Process, Rebecca Altman, Savanna Cathey, Michelle Dedmon May 2023

Analyzing Equity Within The University Of Nevada, Las Vegas Physical Therapy Program Admissions Process, Rebecca Altman, Savanna Cathey, Michelle Dedmon

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose The purpose of this study was to analyze the admissions process of the University of Nevada Las Vegas Physical Therapy (UNLVPT) program through the lens of racial equity. Methods A retrospective cohort of UNLVPT applicants between 2014-2019 was obtained from the physical therapy centralized admissions system and the UNLVPT admissions office. Applicant and application characteristics were compared by racial group. Results: Our sample included 2937 total applicants with 212 (7.2%) that were admitted and matriculated into the program. Applicants identified as 49% White, 24% Asian, 13% multiracial, 6% Hispanic, 2% Black, 0.2% American Indian, and 6% did not report …


The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller May 2023

The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/purpose: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ), developed in 2011 to measure fear of falling avoidance behavior, has good evidence for reliability and validity. However, a recently modified version (mFFABQ) is theorized to be easier to understand for those completing the questionnaire because the Likert responses are more logical in completing the item stem. The purpose of this study was to examine the test-retest reliability and construct validity of the mFFABQ in adults with Parkinson’s Disease (PD) and older adults aged 60-90 years. Methods: Thirty-nine participants (age 72.21 ± 9.5; 29 men, 10 women) diagnosed with PD (diagnosis …