Medicine and Health Sciences Commons^™

A 6 Week Balance And Gait Training Program Using The Alterg For A Patient With Cervical Myelopathy After Spinal Decompression Surgery: A Case Report, Palak Patel

Case Report Posters

Spinal stenosis is the narrowing of the spinal canal which can cause radiculopathy or myelopathy symptoms due to compression of the spinal cord. About 80% of patients of 70 years old have some level of stenosis. There is limited research on prognosis for patients with cervical myelopathy and subsequent spinal decompression surgery. AlterG treadmill (AlterG Anti-Gravity Treadmill M320/F320, Fremont, CA) is an antigravity treadmill that is considered a body weight support system used in progressive gait retraining. The purpose of this case report is to assess the effectiveness of balance and gait training on the AlterG in a geriatric patient …

Restoring Functional Mobility In An Adult Patient Secondary To Subtrochanteric Femur Fracture Surgical Repair: A Case Report, Brittany Gray

Case Report Posters

The National Highway Traffic Safety Administration noted 7,277,000 police reported motor vehicle accidents (MVA) in the United States in 2016.1 As a result, 2,177,000 people were injured. In 2008, approximately 340,000 emergency department visits were because of hip fractures. Femur fractures average $40,000 in medical bills in the first year following injury and another $5,000 in succeeding years. A review of 12 trials resulted in mixed evidence on the necessity of skilled physical therapy (PT) interventions to maximize functional mobility in individuals with femur fractures. The purpose of this case report was to report on the results of skilled PT …

Inpatient Physical Therapy Management For A Patient With Chronic Pulmonary Complications Secondary To Multiple Lobectomies: A Case Report, Bayley Archinal

Case Report Posters

Bronchiectasis is a disease defined by abnormal dilation of the bronchi, which is a result of recurrent infections and/or chronic inflammation. A lobectomy is the surgical removal of one lobe of a lung and reduces the symptoms of bronchiectasis. Patients who undergo this surgery are more likely to have long-term pulmonary limitations. There is little to no literature regarding the long term treatment of patients who underwent multiple lobectomies. The purpose of this case report was to describe an appropriate intervention program for an 82-year-old female who suffered from multiple pulmonary complications secondary to multiple lobectomies.

Barefoot Rehabilitation Of Type Ii Posterior Tibialis Tendon Dysfunction In A Veteran: A Case Report, Matthew Heindel, Kirsten Buchanan

Case Report Posters

The purpose of this case report was to examine barefoot training and foot intrinsic musculature strengthening within a comprehensive PT plan of care for type II PTTD. Posterior Tibialis Tendon Dysfunction (PTTD) affects ~10% of the population, where Stage I: medial arch pain, possible pain with heel elevation, and mild ankle/foot swelling, Stage II: Stage I + flexible flatfoot deformity, Stage III: Stage I + fixed flatfoot deformity, Stage IV: tibiotalar degeneration stemming from valgus tilt of talus in ankle mortise. Barefoot training increased plantar surface proprioception, increased activation of foot intrinsic musculature, decreased running injuries. Foot Intrinsic Musculature Strengthening …

Balance And Strength Interventions For An Older Individual With Peripheral Polyneuropathy: A Case Report, Hanna Geib

Case Report Posters

Peripheral polyneuropathy (PPN) is a condition resulting from damage to the peripheral nervous system. PPN occurs in a distal and symmetrical pattern, often affecting the toes and the soles of the feet. Numbness, tingling, paresthesias, or burning are common symptoms of PPN. 20-25% of cases are idiopathic. Can affect functional mobility due to proprioceptive sensory losses and general weakness of extensor muscles, which then results in unsteadiness of gait and impaired balance. Treatment can consist of pharmacological and physical therapy interventions in order to manage symptoms. Recent literature demonstrated that following participation in a strength and balance training program, individuals …

A Weighted Vest Rehabilitation Protocol To Improve Gait In A Patient With Cerebellar Degeneration: A Case Report, Amy Belanger, Kirsten Buchanan

Case Report Posters

The purpose of this case report was to investigate a combined weighted vest protocol and comprehensive PT program for a 34-year-old with cerebellar degeneration. Cerebellar degeneration (CD) is a rare brain dysfunction that affects motor control. Ataxia is a common manifestation of CD, defined as the discoordination of the limbs or trunk. Interventions that have separately been found to be effective when treating ataxia are postural training, comprehensive physical therapy (PT) and weighted vest protocols. While each of these treatments have individually been shown to decrease ataxia, they have not been used in combination.

Subacute Rehabilitation Following An Hypoxic Ischemic Brain Injury Resulting In Severe Ataxia: A Case Report, Chelsea Vandriel

Case Report Posters

The purpose of this case report is to provide physical therapy interventions that were utilized in an inpatient rehabilitation hospital setting for a patient who experienced a hypoxic brain injury. Hypoxic/anoxic brain injuries result from global lack of oxygen to the brain from events such as drowning, choking, and cardiac or respiratory arrest. Certain areas of the brain have more devastating effects when deprived of oxygen as they have a higher metabolic activity and increased utilization of oxygen. One area in particular is the basal ganglia. Anoxic brain injuries involving infarcts of the basal ganglia (containing globus pallidus) can result …

Functional Mobility For A Patient With Myelodysplastic Syndrome, Chronic Gvhd, And Corticosteroid Use: A Case Report, Alyssa Deardorff, Amy J. Litterini

Case Report Posters

The purpose of this case report is to describe PT interventions for an individual with a cancer diagnosis who received an allo-SCT and subsequently had long-term complications associated with cGVHD, long-term corticosteroid use, and cancer survivorship. Myelodysplastic Syndrome (MDS) is often called pre-leukemia as 1 in 3 individuals will develop Acute Myeloid Leukemia. It is a type of cancer that causes blood producing cells in bone marrow to function abnormally and causes normal blood cells to die earlier. Graft-Versus-Host-Disease (GVHD) develops in approximately 70% of patients following an allogenic stem cell transplant. Donor’s cells attack both the malignancy and the …

The Treatment Of Pes Anserine Syndrome Using Acl Injury Prevention Exercises: A Case Report, Stephanie Chau, Kirsten Buchanan

Case Report Posters

The purpose of this case report was to utilize ACL injury prevention exercises within a comprehensive physical therapy (PT) plan of care (POC) for a patient with Pes anserine syndrome (PAS). Pes anserine syndrome (PAS) is the inflammation of either the pes anserine bursa, tendon, or both. The incidence and etiology of PAS are unknown at this time. There is limited literature available for the treatment and rehabilitation of PAS. Anterior cruciate ligament (ACL) injury prevention exercises address proper hip, knee, and ankle alignment and decrease the risk of ACL injuries by 52% in females and 85% in males.

Inpatient Rehabilitation Of A 99-Year-Old Following A High-Impact Unstable Pelvic Ring Fracture: A Case Report, Julia Pratt

Case Report Posters

The purpose of this case report was to describe the outcomes of PT interventions for a nonagenarian patient following an unstable pelvic ring fracture and to provide an overview for a plan of care supported by research. Unstable pelvic ring fractures are defined by the displacement and deformity of the pelvic bones. Pelvic fractures are rare and only make up 3% of all skeletal injuries; however, the mortality rate of unstable pelvic fractures is extremely high, ranging from 20-50%. Most pelvic fractures are caused by motor vehicle accidents (MVA) in which patients suffer multiple traumas. When patients suffer multiple traumas …

Subacute Physical Rehabilitation For A Young Adult With A Hypoxic Brain Injury Resulting In Severe Myoclonic Movements And Ataxia: A Case Report, Chelsea Vandriel

Case Report Papers

Background and Purpose: An acquired brain injury is an injury to the brain that is not hereditary, congenital, degenerative in nature or induced by birth. Hypoxic/anoxic ischemic brain injuries (HIBI) result from global lack of oxygen to the brain from events such as drowning, choking, and cardiac or respiratory arrest. Limited research has been done regarding physical therapy (PT) interventions to improve functional mobility, gait, and tolerance to activity in an inpatient rehabilitation facility (IRF) with this patient population. Thus, the purpose of this case report is to provide PT interventions that were utilized in an IRF setting for a …

The Treatment Of Pes Anserine Syndrome Using Acl Injury Prevention Exercises: A Case Report, Stephanie Chau

Case Report Papers

Background and Purpose: Pes anserine syndrome is the term that encompasses both pes anserine bursitis and pes anserine tendonitis. The exact incidence of pes anserine syndrome is unknown. However, the etiology has been hypothesized to be due to poor biomechanics and overuse. Treatment protocols with targeted exercises for rehabilitation of pes anserine syndrome have not been well documented. ACL injury prevention programs have been shown to significantly decrease ACL injuries by addressing proper hip, knee, and ankle alignment and biomechanics. It was postulated that utilization of an ACL injury prevention program could also be an effective strategy in addressing the …

Restoring Functional Mobility In An Adult Patient Secondary To Subtrochanteric Femur Fracture Surgical Repair: A Case Report, Brittany Gray

Case Report Papers

Background and Purpose: Femur fractures lead to significant functional deficits resulting in major healthcare expenses. This case report accounts the outcomes of skilled physical therapy interventions for treatment of an intramedullary nail fixation of a subtrochanteric fracture. The purpose of this case report was to demonstrate the use of physical therapy in regaining strength, range of motion, and improving gait and balance deficits post femur fracture. The combination of the patient’s age, mechanism of injury, post-surgical complications, and delayed full weight bearing status make this case distinctive in nature. Case Description: The patient was a 47-year-old male who presented to …

Inpatient Rehabilitation Of A 99-Year-Old Patient Following A High-Impact Unstable Pelvic Ring Fracture: A Case Report, Julia Pratt

Case Report Papers

Background: Unstable pelvic ring fractures (PRF) seldom occur in isolated injuries. Most pelvic fractures are caused by motor vehicle accidents (MVA) concurrently with multiple traumas. PRF have an extremely high mortality rate, ranging from 20-50%. When patients suffer multiple traumas including a pelvic fracture, their mortality rate increases by 10%, and their ability to return home after treatment decreases by 33%. The purpose of this case report was to describe the outcomes of physical therapy (PT) interventions for a nonagenarian patient following an unstable PRF. Case Description: A 99 year-old male suffered a high impact unstable PRF in addition to …

A 6 Week Balance And Gait Training Program Using The Alterg For A Patient With Cervical Myelopathy After Spinal Decompression Surgery: A Case Report, Palak Patel

Case Report Papers

Background and Purpose: Spinal stenosis is the narrowing of the spinal canal, which can cause radicular symptoms due to compression of the spinal cord. About 80% of patients over 70 years old have some level of stenosis. Patients with severe types of cervical stenosis may require operative management which includes spinal decompression and fusion. In this case report the AlterG was used to perform a balance and gait training program for a patient who had significant loss of strength and functional mobility after spinal decompression surgery. Case Description: The patient was an 83-year-old male who was a retired farmer that …

Comprehensive Physical Therapy Management Of A Patient With Decreased Shoulder Function And A History Of Breast, Lung, And Oral Cancer: A Case Report, Andrew Chongaway

Case Report Papers

Background: Cancer treatments can have late effects on the musculoskeletal, cardiopulmonary, nervous, and integumentary systems. This case report describes comprehensive physical therapy (PT) management of decreased shoulder function for a patient with a history of breast, lung, and tongue cancers treated with surgery, chemotherapy, and radiation. Case Description: The patient was a 71-year-old female referred to outpatient PT for right shoulder and neck pain with the goals to reduce pain and increase functional mobility. Past history included local cancer treatment occurred to the right upper quadrant for multiple cancers. Outcome measures included the Upper Extremity Functional Scale (UEFS), the Numeric …

A Barefoot Running Program For A College Lacrosse Player With Chronic Exertional Compartment Syndrome: A Case Report, Erica Mazzarelli

Case Report Papers

Background and Purpose: Although barefoot running has been investigated for anterior and lateral exertional compartment syndrome, a specific barefoot running program aimed at altering running mechanics has not been determined for posterior exertional compartment syndrome for a college lacrosse player. The purpose of this case report was to examine the effects of adopting a forefoot running pattern through a barefoot running program in a 20-year-old college lacrosse player with posterior chronic exertional compartment syndrome (CECS) in conjunction with a comprehensive physical therapy program. Case description: The patient was a 20-year-old female college lacrosse player who presented to physical therapy with …

Mckenzie Approach To Treating Lumbar Radiculopathy With A Lateral Shift: A Case Report, Carly Theriault

Case Report Papers

Background and Purpose: Pain and dysfunction of the lumbar spine has the highest incidence of any other musculoskeletal condition. LBP is thought to affect 70-85% of people. The purpose of this case report was to implement the McKenzie method, along with manual therapy, strengthening and stretching exercises, modalities, patient education, and an HEP for a patient with lumbar radiculopathy. Case Description: The patient was a 59-year-old male with an eight-year history of LBP. Following his most recent injury, the patient had LBP with pain radiating to the right LE. The patient received PT treatment twice a week for eight weeks. …

Shoulder-Specific Patient Reported Outcome Measures For Use In Patients With Head And Neck Cancer:An Assessment Of Reliability, Construct Validity, And Overall Appropriateness Of Test Score Interpretation Using Rasch Analysis, Melissa Michelle Eden

Department of Physical Therapy Student Theses, Dissertations and Capstones

Context: Medical management for head and neck cancer (HNC) often includes neck dissection surgery, a side effect of which is shoulder dysfunction. There is no consensus for which patient-reported outcome measure (PRO) is most appropriate to quantify shoulder dysfunction in this population.

Objective: The aims of this research study were to: (1) use Rasch methodologies to assess construct validity and overall appropriateness of test score interpretation of Disability of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI) and Neck Dissection Impairment Index (NDII) in the HNC population; (2) determine appropriateness of use of University of …

Calcitriol And Calcipotriol Modulate Transport Activity Of Abc Transporters And Exhibit Selective Cytotoxicity In Mrp1-Overexpressing Cells, Kee W. Tan, Angelina Sampson, Bremansu Osa-Andrews, Surtaj H. Iram

Chemistry and Biochemistry Faculty Publications

Efflux transporters P-glycoprotein (P-gp/ABCB1), multidrug resistance protein 1 (MRP1/ABCC1), and breast cancer resistance protein (BCRP/ABCG2) can affect the efficacy and toxicity of a wide variety of drugs and are implicated in multidrug resistance (MDR). Eight test compounds, recently identified from an intramolecular FRET-based high throughput screening, were characterized for their interaction with MRP1. We report that the active metabolite of vitamin D3, calcitriol, and its analog calcipotriol are selectively cytotoxic to MRP1-overexpressing cells, besides inhibiting transport function of P-gp, MRP1, and BCRP. Calcitriol and calcipotriol consistently displayed a potent inhibitory activity on MRP1-mediated doxorubicin and calcein efflux in MRP1-overexpressing H69AR …

Practical Pearl: Mental/Behavioral Health Complaints - Dec 2018, Joeli Hettler Md

Pediatrics Practical Pearls: Referral Guidelines for Common Problems

No abstract provided.

Female Athlete Triad: Strategic Plan, Kaitlyn Savard, Carly Theriault, Polina Weinstein, Mayra Zerpa Calderon

Physical Therapy Administration

The following is a blueprint for creating a screening and educational program focused on the Female Athlete Triad. Our program intends to promote awareness, encourage women to take action regarding their health needs, and reduce the stigma surrounding this underdiagnosed and undertreated health issue. Created during the Fall 2018 semester of the Physical Therapy Administration course, this strategic plan contains all values, rationale, and strategies for reaching the target population and addressing this health issue.

Female Athlete Triad: Presentation, Kaitlyn Savard, Carly Theriault, Polina Weinstein, Mayra Zerpa Calderon

Physical Therapy Administration

Presentation created to summarize a strategic plan and screening program focused on the Female Athlete Triad. Program intends to promote awareness, encourage women to take action regarding their health needs, and reduce the stigma surrounding this underdiagnosed and undertreated health issue.

The Use Of Theory-Based Formative Research To Design Suicide Prevention Messaging For U.S. Veterans In Midlife., Elizabeth Karras, Cara M. Stokes, Sara C. Warfield, Heather Elder, Brady Stephens, Robert M. Bossarte

Clinical and Translational Science Institute

Background. Communication campaigns offer a viable mechanism to promote suicide prevention and reinforce mental health for U.S. veterans in midlife, a group with a high suicide burden. However, little empirical investigation of this type of messaging has been conducted, with formative campaign research conspicuously missing from the limited literature. Aims. Using the theory of planned behavior as a guide, formative research was conducted to inform the design of suicide prevention messaging by (a) describing and measuring several theoretical constructs among our audience and (b) modeling associations between constructs and intentions to seek help for suicidal behaviors and mental health more …

Predictors Of Major Bleeding Among Working-Age Adults With Atrial Fibrillation: Evaluating The Effects Of Potential Drug-Drug Interactions And Switching From Warfarin To Non-Vitamin K Oral Anticoagulants, Xue Feng, Usha Sambamoorthi, Kim Innes, Gregory Castelli, Traci Lemasters, Lianjie Xiong, Michael U. Williams, Xi Tan

Clinical and Translational Science Institute

Purpose This study aims to evaluate the associations between switching from warfarin to non-vitamin K oral anticoagulants (NOACs), exposure to potential drug-drug interactions (DDIs), and major bleeding events in working-age adults with atrial fibrillation (AF). Methods We conducted a retrospective cohort study using the claims database of commercially insured working-age adults with AF from 2010 to 2015. Switchers were defined as patients who switched from warfarin to NOAC; non-switchers were defined as those who remained on warfarin. We developed novel methods to calculate the number and proportion of days with potential DDIs with NOAC/warfarin. Multivariate logistic regressions were utilized to …

Healthcare Utilization And Expenditures In Working-Age Adults With Atrial Fibrillation: The Effect Of Switching From Warfarin To Non-Vitamin K Oral Anticoagulants, Xue Feng, Usha Sambamoorthi, Kim Innes, Traci Lemasters, Gregory Castelli, Nilanjana Dwibedi, Xi Tan

Clinical and Translational Science Institute

Objective Our objective was to evaluate the association between switching from warfarin to non-vitamin K oral anticoagulants (NOACs) and potential drug–drug interactions (DDIs), healthcare utilization, and expenditures in working-age adults with atrial fbrillation (AF). Methods We conducted a retrospective cohort study using data from 2010 to 2015 for patients who switched from warfarin to NOACs (switchers) and those who continued to receive warfarin (non-switchers). We identifed medications known or suspected to have clinically signifcant interactions with NOACs or warfarin. We used multivariate logistic regression, negative binomial, and generalized linear models to evaluate the infuence of switching to NOACs and of …

Aerobic Exercise And Fatigue In Rheumatoid Arthritis Participants: A Meta-Analysis Using The Minimal Important Difference Approach, George A. Kelley, Kristi S. Kelley, Leigh F. Callahan

Clinical and Translational Science Institute

Objective To use the minimal important difference (MID) versus the standardized mean difference (SMD) approach in order to provide more robust and clinically relevant information regarding the association between land‐based aerobic exercise and changes in self‐reported fatigue among adults with rheumatoid arthritis (RA). Methods Data from a previous meta‐analysis of 5 randomized controlled trials that represented up to 298 participants per study were utilized to calculate 9 effect sizes, using the MID approach. Data used to obtain the MID were derived from previously reported anchor‐based values specific to each fatigue instrument in adults with RA. Results were pooled using a …

Gradual Common Carotid Artery Occlusion As A Novel Model For Cerebrovascular Hypoperfusion, Dominic D. Quintana, Xuefang Ren, Heng Hu, Elizabeth B. Engler-Chiurazzi, Stephanie L. Rellick, Sara E. Lewis, Jessica M. Povroznik, James W. Simpkins, Mohammad Alvi

Clinical and Translational Science Institute

Chronic cerebrovascular hypoperfusion results in vascular dementia and increases predisposition to lacunar infarcts. However, there are no suitable animal models. In this study, we developed a novel model for chronic irreversible cerebral hypoperfusion in mice. Briefly, an ameroid constrictor was placed on the right carotid artery to gradually occlude the vessel, while a microcoil was placed on the left carotid artery to prevent compensation of the blood flow. This procedure resulted in a gradual hypoperfusion developing over a period of 34 days with no cerebral blood flow recovery. Histological analysis of the brain revealed neuronal and axonal degeneration as well …

Oxygen-Induced Leakage Of Spin Polarization In Overhauser- Enhanced Magnetic Resonance Imaging: Application For Oximetry In Tumors, Artem A. Gorodetskii, Timothy D. Eubank, Benoit Driesschaert, Martin Poncelet, Emily Ellis, Valery V. Khramtsov, Andrey A. Bobko

Clinical and Translational Science Institute

Overhauser-enhanced Magnetic Resonance Imaging (OMRI) is a double resonance technique applied for oxygen imaging in aqueous samples and biological tissues. In this report, we present an improved OMRI approach of oxygen measurement using the single line “Finland” trityl spin probe. Compared to a traditional approach, we introduced an additional mechanism of leakage of spin polarization due to an interaction of a spin system with oxygen. The experimental comparison of the new approach with an oxygen-dependent leakage factor to a traditional approach performed in phantom samples in vitro, and mouse tumor model in vivo, shows improved accuracy of determination of oxygen …

Inpatient Physical Therapy Management For A Patient With Chronic Pulmonary Complications Secondary To Multiple Lobectomies: A Case Report, Bayley Archinal

Case Report Papers

Background and Purpose: Bronchiectasis is a disease defined by abnormal dilation of the bronchi from recurrent infections and/or chronic inflammation, which can lead to irreversible lung damage. Based upon severity and patient response to conservative treatment, a lobectomy may be required to resolve their symptoms. Though surgery may provide symptom relief and improve overall quality of life, patients are likely to have long-term pulmonary complications. There are several studies regarding the treatment of patients with pulmonary limitations secondary to a lobectomy. However, there is little to no evidence regarding the long-term treatment of patients who have undergone multiple lobectomies. The …